La consultation prénatale a été exportée vers les pays en voie de développement telle qu'elle était conçue dans les pays industrialisés, sans questionnement sur son efficacité pour diminuer les morbidités et mortalités maternelles et néonatales. Les conclusions des études les plus récentes conduisent à penser que quatre CPN par grossesse (12, 26, 32, 36 SA) permettent de mettre en place les interventions d'efficacité prouvées pour la mère et le nouveau-né. Elles doivent permettre de

Ces mesures potentiellement efficaces n'auront d'impact réel que si le système de santé maternelle est organisé et les différents services mis en réseaux, si la qualité des soins est respectée et si les relations personnels de santé/population se font dans le respect mutuel.

Les femmes africaines utilisent largement les CPN lorsqu'elles sont accessibles : cette chance doit être mise à profit pour mettre en place les actions d'efficacité avérée.

Prenatal care has been implemented in developing countries according to the same mode as applied in industrialized countries without considering its real effectiveness in reducing maternal and neonatal mortality. Several recent studies suggest that the goals should be revisited in order to implement a program of prenatal care based on real scientific evidence. Based on the current literature, we propose a potentially effective content for prenatal care adapted to the context of developing countries.

Four antenatal consultations would be enough if appropriately timed at 12, 26, 32 and 36 weeks pregnancy. The purpose of these consultations would be: 1) to screen for three major risk factors, which, when recognized, lead to specific action: uterine, scare, malpresentation, premature rupture of the membranes; 2) to prevent and/or detect (and treat) specific complications of pregnancy: hypertension, infection (malaria, venereal disease, HIV, tetanus, urinary tract infection); anemia and trace element deficiencies, gestational diabetes mellitus; 3) to provide counseling, support and information for pregnant women and their families (including the partner) concerning: severe signs and symptoms of pregnancy and delivery, community organization of emergency transfer, delivery planning.

These potentially effective actions can only have a real public health impact if implemented within an organized maternal health system with a functional network of delivery units, if truly quality care is given, and if the relationships between health care providers and the population are based on mutual respect.

Sub-Saharan African women use prenatal care extensively when it is accessible; this opportunity must be used to implement evidence-based actions with appropriate and realistic goals.