Which types of perinatal events are predictable? A look at a risk score model

A weighted risk index for antenatal prediction of perinatal outcome

OBJECTIVE

The hypothesis is that a risk score derived from the risk index (RI) is correlated with perinatal outcomes.

STUDY DESIGN

The RI is a weighted numerical score based on gestational risk factors applied to 782 gravidas antepartum. Management was independent of the score. Birth weight, Apgar scores, and cesarean birth were correlated with risk score.

RESULTS

The break point score in this non-Gaussian cohort was 6. Using 6, 80.2% were low and 19.8% high risk. Birth weight < 2500 gm was inversely correlated (p < .001) and occurred in 13% of the high risk ((3)6) and 4.9% of the low risk (< 6) group, relative risk (RR) 2.7. C-section correlated (p < .001), and occurred in 51% of the high and 23% of the low risk group, RR 2.4. risk score inversely correlated with 5 minute Apgar (RR 4.7 p < .002) but not the 1 minute Apgar score.

CONCLUSION

The RI identified gravidas at risk for low birth weight, low 5 minute Apgar score, and cesarean birth.

Factors associated with high risk of perinatal and neonatal mortality: an interim report on a prospective community-based study in rural Sudan

In a community-based prospective study, 6275 deliveries resulting in 6084 livebirths, 150 stillbirths (SB) and 167 neonatal deaths (NND) were monitored over a period of 3 years. The risk of an unfavourable outcome (SB or NND) in multiple pregnancies was more than ninefold that of singletons. Teenage mothers and those over 34 years of age ran nearly twice the risk of having an unfavourable outcome of pregnancy compared with mothers aged 20-29 years. First pregnancy and grand-multiparity (greater than eight previous pregnancies) carried a similar risk of an unfavourable outcome compared with mothers with 1-4 previous pregnancies. The most serious risk factor was the adverse outcome of the previous pregnancy. Compared with mothers whose last outcome had resulted in a livebirth surviving at least 30 days, mothers with a previous SB had seven times the risk (adjusted for age and parity) of SB and more than twice the risk of NND in the current pregnancy. Maternal illiteracy was associated with significantly higher risk of NND, and this rate decreased with increasing years of education. Frequency of antenatal visits had a marginally significant effect on the SB rate. Socioeconomic factors, diet and iron supplementation during pregnancy did not seem to affect the outcome.