Antenatal Risk Scoring Form: Statistical Analysis of 1175 Cases

Abstract

An antenatal risk scoring form was devised. The form contains 23 risk factors in three categories: reproductive history, associated medical conditions, and the present pregnancy. Numerical scores were arbitrarily assigned to each factor. The form was applied retrospectively to 1175 deliveries, and a total score was obtained for each case. The total score was related to perinatal death, preterm birth, Apgar score, and low birth weight. It was found that increasing score was significantly associated with poor outcome. The scores were grouped into low risk, high risk, and extreme risk. This system identified 25% of the study population as high and/or extreme risk, which in turn accounted for 94% of perinatal deaths. Although such a form in general has potential limitations and should not replace clinical judgment, its simplicity and demonstrated ability to assist in high-risk selection refines risk assessment for the experienced physician and quantifies it for the neophyte. It is recommended that the form be included in the prenatal records of all patients. Obstetricians have long recognized the need for varying levels of care. Pregnant patients with certain complications have an increased chance of having a complicated pregnancy course and an infant who has a complicated course; therefore,these patients require more intensive observation and care than usual. However, in our communities, well-trained personnel and resources are limited. The accurate identification of patients requiring different levels of care is a major concern, for both the individual physician and the patient and in planning regional perinatal resources. A number of high-risk pregnancy scoring systems have been proposed, 1-6 but in general, information derived from them has not proved discernibly superior to expert clinical judgment. Many of the scoring forms are too extensive andcomplicated to be filled out by a busy clinician, without whose enthusiastic cooperation no screening system can ever be expected to function effectively. In addition, not all of the known risk factors in pregnancy are universally applicable. It has been shown that some of the accepted risk factors may not have the

Identifying High Risk Pregnancy and Its Effectiveness in determining Maternal and Perinatal Outcome

“…Apgar score below 7 at 1 and 5 minutes was more common in extremely high risk pregnancy compared to high risk and low risk pregnancies in our study; 4,10,23 similar to findings of the other studies.…”

“…Studies using Du a and Das scoring system reported prevalence of high risk pregnancy to range from 20 to 30% and that of 9,10,22 moderate risk pregnancy to range from 15 to 33%. Other studies using various other scoring systems have a wide variance in 5,6,7,23,24 prevalence of high risk pregnancy-18 to 33%. The variance in the prevalence is due to different criteria and tools used for stra fica on of pregnancy into high risk groups and due to different study popula on and study se ng.…”

“…Prematurity was not analyzed as it was one of the risk factors used in the scoring system. Prematurity was reported to be more 4,7,10,23 common in high risk pregnancy in various studies. One third of the neonates required NICU admission in the extremely high risk group compared to 9.2% and 4.5% neonates in high risk and low risk pregnancy respec vely.…”

Association of Antenatal Risk Score With Maternal and Neonatal Mortality and Morbidity

“…The distribution and the categorization of low (56% vs. 66%), moderate (34% vs. 29%), and high- (9.4% vs. 4.8%) risk pregnancies in this study was similar to that reported in a previous population-based study conducted in Canada except for the percentages of high-risk pregnancies [ 4 ]. The difference in high-risk pregnancies might be expected as KAMC is a tertiary referral center that accounted for 94% of perinatal deaths [ 2 ].…”

“…High-risk pregnancies are those with factors associated with increased perinatal morbidity and mortality of pregnant women, fetuses, and neonates. Monitoring antenatal risk is a crucial element of routine care 1, 2, 3 4 5 5 5 6 7 8, 2, 9 during pregnancy [1,2]. Antenatal risk scores are numerical indices that reflect the combined risk of existing maternal variables to identify women with high-risk pregnancies and prevent maternal and fetal complications.…”