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All studies so far discussed
divided women into high or low risk groups based on
previous obstetric and
medical history. This has been examined further in
several studies and each individual risk factor has
been ascribed a numerical value in order to objectively
determine a woman’s overall risk and label her as high
or low risk accordingly. Some have tried to weight
different risk factors but this has not so far been
successful. In addition the significance off adding
several small similar risks together to make a much
larger risk has been questioned. Finally the question
of timing has not been addressed. At the beginning
of a pregnancy there is the maximum time to adjust
pregnancy outcome but later on in pregnancy, events
may alter a woman’s prior risk.
Although observational studies have suggested a reduction
in premature deliveries as a result of this risk scoring,
other studies have found that only 10-30% of those
women labelled high risk actually experienced an adverse
outcome ( 1, 2, 3, 4, 5).
Conversely between 20-50% of those women who deliver
a preterm or small for gestational age infant, are
low risk on prior scoring (6).
Effective risk scoring also relies upon the ability
to prevent or modify adverse outcome once it is identified.
However, there are relatively few interventions proven
to be of value in antenatal care.
References
1. Lilford R J, Chard T. Problems and pitfalls of
risk assessment in antenatal care. British Journal
of Obstetrics and Gynaecology.1983; 90: 507-510, Abstract
2. Keirse MNJC. Interaction between primary and secondary
care during pregnancy and childbirth. In: Effective
Care in Pregnancy and Childbirth. Editors: Chalmers
I, Enkin M, Keirse MJNC. Oxford: Oxford University
Press, 1989; pp197-201.
3. Hall MH. Identification of low risk and high risk.
Bailliers Clinical Obstetrics and Gynaecology 1990;
4: 65-76, Abstract
4. Chard T, Learmont J, Caroll S, Hudson C, Lloyd
DS, Sloan D. Evaluation of a fetal risk scoringsystem.
American Journal of Perinatology 1992; 9: 388-393, Abstract
5. Shiono PH, Klebanoff MA. A review of risk scoring
for preterm birth. Clinics in Perinataology. 1993;
20:107-125, Abstract
6. Enkin M, Keirse MJNC, Neilson J, Crowther C, Duley
L, Hodnett E, Hofmeyr J. Risk scoring In: A guide to
effective care in pregnancy and childbirth. Oxford:
Oxford University Press, 2000; pp49-52.
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