Obstetric risk assessment in rural practice.
A study was undertaken to evaluate Coopland's obstetric risk index in a rural primary care setting. Information on 635 pregnant women cared for in a rural practice was collected prospectively. Adverse outcome was defined as perinatal death, birthweight less than 2500 g, 5-minute Apgar score less than 7, or newborn transferred to a level 2 or level 3 nursery. Forty-seven pregnancies (8.3%) had an adverse outcome. There was a clear relationship between risk score and probability of adverse outcome. Good sensitivity could be achieved only at the expense of a very high false-positive rate, however. The index can be used to identify a subgroup of women at relatively high risk for adverse outcome, but the majority of adverse outcomes will occur in women identified as low risk. The risk-scoring system in this population was no more effective than a policy that would refer all women with standard obstetric risk factors.
LeFevre
M
M
Department of Family and Community Medicine, University of Missouri, Columbia 65212.
Williamson
H A
HA
Hector
M
M
D000328:Adult; D001034:Apgar Score; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008923:Missouri; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012423:Rural Health; D012680:Sensitivity and Specificity