Appropriate technology: antenatal care.

Appropriate health technology should be effective, safe and feasible. The current antenatal care model originated from western countries. The absence of direct randomized, controlled trials precludes a straight forward evaluation of the impact of prenatal care on birth outcomes. Interventions of proven benefits in eliminating or alleviating adverse maternal outcomes include routine iron and folate supplementation in areas of high anemia prevalence, hemoglobin determination late in pregnancy, screening for asymptomatic bacteriuria by urine culture or dipstick, serologic screening and treatment of syphilis, obtaining a history of difficult labor in multipara or height in nullipara and external cephalic version at term. Interventions of proven benefits in eliminating or alleviating adverse newborn outcomes include routine measurement of fundal height, reduction of maternal physical strain, diagnosis and treatment of tuberculosis, malaria prophylaxis, adequate tetanus immunization, antenatal and perinatal Zidovudine in HIV-positive mothers and one vaginal examination during pregnancy. Only these interventions of proven benefits should be implemented.