Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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Appendix E: Review of Obstetrical Risk Assessment Methods
Appendix E: Review of Obstetrical Risk Assessment Methods
Pages 149-170
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From page 149... ...
They include demographic data, socioeconomic data, data based on past pregnancies, medical history, present pregnancy and, in the more recent studies, data on fetal heart rate and uterine contractions from electronic monitoring. All authors have baaed their selection of factors on the existing information concerning variables associated 149
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From page 150... ...
bad color 2 • 9-d aua points, 10 1a beat, arbitrary Prachtel, Sa.ple 30' lladical 1,378 Obatat- 42 Obatetrical and IIOCio- Yea Yea 3 and 10 1 point for Abnor.. l U67 higb-riak vo.en, record~ ~ deal ec:onoaic (SBSI variables, daya after each non- neurology Ul study groupo Score 58 neurological signa birth optlaal 0 infanta born factor, in boapital aua points Larks and Coneec:utive Obaarvatioa 2,028 54 DeiiOgraphic characterie- Yes Multivariate AP9ar Larks, lt68 births tics, blood presaure of acora acore1 110thar, bioelectrical 110rtallty -••urea »asbitt and Coneec:utive Obaarvatlon 1,001 MCB care !
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From page 151... ...
1969 Britainr still- birth and births and death car 7,851 social class, height, each factor and sua .... Ul neoutal deaths tificates pre-eclaapsia, and for 3 110nths 8110king Alberasn and Goldstein, 1970 rr- Perinatal Mortality Surveyr iden• tify children at 7 years ·- 12,083 Hone 167 with handicaps 3 Parity 4+, adverse aethod of delivery, neonatal illness in 1st week of life Yes Yes Yea One point for preHnce of factor Handicap with and without handicaps Bffer, 1969 All adaissions Records 211 Prognostic 155 Pathology, Assigned Not clear, Apgar to high-risk 350 Risk Score test results, at labor aasuae 1 pregnancy unitr deaagraphic and au, point if rancSo.
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From page 152... ...
Yea Yes Yea .... sa out perinatal death 5,235 Chik at al., Conaecutively Intervi.., and 4,500 Sobel'• 36 s ...
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From page 153... ...
123 Socioecono~~ic, Yea Yea Yea Multivariate Morbidity 1! 175 with follow-up SCore past pregnancies, ecore baaed aortality of infant B • hlatory preHnt pregnancy, on frequency P • prenatal and labor in poor out L • labor caae group N • neonatal aultlplled by factor of Hriouaneasr SUB
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From page 154... ...
Stage When Collecte4 Scoring of of Data Sub- rae- Pre- Intra- Manner of Outc011e of Reference Design Source a jecta Title tors Pactora Inclu4e4 natal partu11 Neonatal Scoring Interest Cora4ello et al., Unknown1 None 41 Not apeciUe4 Yea Yea Not Mortality 1975 retroapecti ve Unknown 1,067 apecitie4 prospective Unknown 230 Ala anCI Neurologically ObHrvation Braselton, 1975 auapect infanta 53 Braselton 46 Behavioral, Yea Behavioral Neonatal followe4 for Bxa• neurological, factors 9et JDOrbi4ity 7 yean vi9or anCI attention, 9 points, .otor activity, an4 reflex tone autono.ic ..aaurea 9et reaponae 4 pointa1 BUll Ja..a et al., w-en elec- Recor4a 665 PHR-UP9. 10 Characteriatica of Yea Use4 Neonatal 1976 tronically Monitoring fetal heart rate an4 Receiver morbi4ity .onitore4 Score uterine preaaure Operator ....
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From page 155... ...
. A thorough understanding of findings concerning fetal heart rate and judicious decisions about their clinical importance are necessary for successful prediction of outcomes (Chik et al., 1979)
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From page 156... ...
.d • 2-6 1- • 0-1 .... U'l Larka and No title• Rot known 0\ Larka, Multi 1968 a 2 for stillbirth • 41~ variate a 2 for death in 2 years • 41' 8COrlng ...bitt and MCB Care 30 3t 31 6 47 32 28 19 4 ll 43 33 27 23 10 3 43 31 29 27 2.6 Aubry' 196!
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From page 157... ...
rete to -800 (low riakl Albe~n No title• 13 87 1.4 26 87 13 74 1.2 endGold- high • (Bandicepa only) etein, 1970 preHnce of eny 1 factor ~ Bffer, 1969 Prognoatic (high riak group)
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From page 158... ...
l! licationa Low Birth wei9ht !
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From page 159... ...
•-lnakl No ~1~~-· 16 22 62 39 63 3.
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From page 161... ...
The incidence rate is provided for the outcome measures displayed in Table 2, i.e., neonatal complications, low birth weight, and perinatal death. A measure of incidence rather than prevalence was used because these conditions do not endure as long as conditions such as cancer or diabetes.
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From page 162... ...
Predictive value, on the other hand, varies with incidencer the predictive value of the high-risk assignment with low birth weight as the outcome is 20 percent, and with perinatal death it is 4 percent. The role of sensitivity is to permit correct assignment of women with undesirable outcomes to a high-risk group prior to actual fulfillment of the outca.e.
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From page 163... ...
(1979) used Robel's method, plus fetal monitoring, to achieve sensitivity and false negative rates siailar to those Robel's method achieved with aultivariate scoring.
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From page 164... ...
None of the methods reviewed place many women with perinatal deaths at low risk incorrectly. The predictive value of a low-risk label for subsequent perinatal death is high, i.e., 98 percent of women in the low-risk group have live infants at the end of the perinatal period.
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From page 165... ...
The predictive value of low-risk labelling by the time labor begins is 85 percent because 15 percent of women required transfer. Rote that COdMOnly used risk assessment methods are aimed at predicting perinatal mortality and not maternal or intrapartum ca.plicationa.
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From page 166... ...
It is fair to say, •This person may be at higher risk,• but is incorrect to say, •This person will experience the outooae because of the presence of these risk factors.• The predicted risk of a neonatal death in
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From page 167... ...
The perforaance of screening to assign correctly women who will have no problems during pregnancy and child birth to a low-risk group should be seriously considered. From the point of view of alternative birth centers, high false negative rates vis-a-vis perinatal death are anatheaa to the concept of women delivering out of hospital.
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From page 168... ...
1975. Comprehensive neonatal assessment (Brazelton Neonatal Behavior Assessment)
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From page 169... ...
1973. Prediction of low birthweight and prematurity by a multiple regression analysis with aaternal characteristics known since the beginning of the pregnancy.
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From page 170... ...
1969. Groups at risk in low birthweight infanta and perinatal .ortality.
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