A scoring system for the prediction of successful delivery in low-risk birthing units.
OBJECTIVE
To establish and test the effectiveness of a low-risk scoring system to predict obstetric outcome for the selection of women suitable for confinement in low-intervention units.


METHODS
Retrospective analyses were performed on data from 2900 women enrolled in the Western Australian Pregnancy Cohort Study and 1353 women managed at a midwifery-based birth center. A combination of the principal predictors of obstetric outcome, incorporating a previously published scoring system and various clinical features, was used to exclude high-risk cases at 18 weeks' and 36 weeks' gestation. Stepwise multivariate logistic regression analyses of the remaining pregnancies then produced a low-risk scoring system.


RESULTS
This system predicted a 55% chance of an uncomplicated delivery in a midwifery-based setting after allocating 54% of women to the low-risk category. It predicted an 82% chance of an uncomplicated delivery in a primary medical care setting with the allocation of 84% of women as low risk.


CONCLUSIONS
The results of this study suggest that adding induction and augmentation of labor, together with low pelvic instrumental delivery, to the treatment options in a low-intervention unit would raise the rate of successful confinement within the unit from 55% to 82%. Our scoring system now requires prospective evaluation to further assess its clinical value.
Koong
D
D
Womens and Infants Research Foundation, University of Western Australia, King Edward Memorial Hospital, Subiaco.
Evans
S
S
Mayes
C
C
McDonald
S
S
Newnham
J
J
D000328:Adult; D003696:Delivery Rooms; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D016015:Logistic Models; D009721:Nurse Midwives; D009774:Obstetrics; D018579:Patient Selection; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis / Q000592:standards*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000592:standards*