Prenatal and intrapartum high-risk screening: I. Prediction of the high-risk neonate

Abstract

A high-risk pregnancy screening system based on a prospective analysis of prenatal, intrapartum, and neonatal factors in 738 pregnancies can predict perinatal morbidity and mortality. Factors were assigned with weighted values according to their assumed risk. Total scores for the prenatal, intrapartum, and neonatal period were dichotomized to simplify the scoring system by forming a low-risk group (scores < 10) and a high-risk group (scores ≥ 10). Three hundred and forty patients (46 per cent) were low risk during both the prenatal and intrapartum period (low/low risk group). In this group the incidence of high-risk neonates and the perinatal mortality rate was extremely low. There was no significant increase in neonatal morbidity or perinatal mortality in 135 patients (18 per cent) who were identified as high risk during the prenatal period but low risk during the intrapartum period (high/low risk group). However, in 144 patients (20 per cent) at risk only during the intrapartum period (low/high risk group) or in 119 patients (16 per cent) at risk during both prenatal and intrapartum periods (high/high risk group) there was a significant increase in the number of high-risk neonates and perinatal mortality. By a stepwise multiple regression analysis, actual intrapartum scores are most predictive of neonatal risk (days in hospital) followed by actual prenatal scores. Identifying a population as to their risk status for both the prenatal and intrapartum period has added depth to the understanding of the continuum of risk which exists within the framework of the perinatal period.