Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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3: Risk Assessment
3: Risk Assessment
Pages 45-54
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From page 45... ...
Much of the controversy surrounding childbirth settings would no longer exist if it were possible to predict with certainty that a low-risk woman or her fetus would experience no complications when delivering in a nonhospital setting. Research is needed to develop more accurate risk assessment instrumentsa While most instruments are useful for predicting neonatal mortality, they are less useful for predicting neonatal morbidity or maternal complications.
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From page 46... ...
In assessing risk for alternative birth sites, the percentage of women assigned a low-risk score who subsequently experience ca.plications is important. Most existing risk assessment instruments show good ability to predict that a low-risk pregnancy will net result in a perinatal deatha More than 98 percent of woaen classified as low risk will have live infanta at the end of the perinatal period.
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From page 47... ...
Many current risk assessment methods are not as successful as the Apgar score in differentiating high- and low-risk groups for some specific neonatal outcomes. Selection of Variables for Obstetric Risk Assessment Variables common to most risk assessment instruments include demographic and socioeconomic data, data from past pregnancies, past medical history, and present pregnancy.
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From page 48... ...
Each of the variables included in a risk assessment instrument has some association with the outcome of interest, the strength of the association differing among variables. Low birth weight, for example, is more strongly associated with neonatal mortality than is maternal education.
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From page 49... ...
The cut-points for declaring risk level are iaportant and, ideally, should be derived for each population to be studied. TWo populations with different d..ograpbic characteristics aay require different cut-points for accurate declaration of bigb risk.
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From page 50... ...
Because these instruments are currently used in many freestanding birth centers to admit prospective parents into the program, investigators will have to ascertain which instrument is being used. A large number of false negatives occuring in groups assigned a low-risk score could lead to incorrect conclusions about the childbirth setting under study.
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From page 51... ...
In Table 2 of Appendix E, for example, columna labeled •fal-• provide percentages of false negatives in studies reporting neonatal complications, low birth weight, or perinatal mortality outcomes. More than 20 percent of women or their infanta experiencing undesirable outcomes typically have been assigned to a low-risk group.
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From page 52... ...
LIMITATIONS OF CURRBRT INSTRUMENTS Current risk assessment instruments employ one set of weights for all mothers, regardless of the major d..agraphic factors of age, ethnic group, and socioeconomic group. Yet there probably are group differences in responses to problems identified by risk factors.
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From page 53... ...
1973. Measuring obstetric risks of prematurity1 A preliminary analysis of neonatal death.
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From page 54... ...
1969. Groups at risk in low birthweight infants and perinatal mortality.
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