title: An instrument for broadened risk assessment in antenatal health care including non-medical issues.
abstract: BACKGROUND
  Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting.
  
  
  METHODS
  A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers.
  
  
  RESULTS
  The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined.
  
  
  CONCLUSIONS
  The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Amber A
authors.initials: AA
authors.lastname: Vos
authors.affiliation: University of Applied Science, Centre of Expertise Innovations in Care, Rotterdam, The Netherlands.
authors.forename: Mieke J
authors.initials: MJ
authors.lastname: van Veen
authors.affiliation: Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Birnie
authors.affiliation: Department of Social & Behavioural Sciences, Erasmus University College, Rotterdam, The Netherlands.
authors.forename: Semiha
authors.initials: S
authors.lastname: Denktaş
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Department of Public Health, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
keywords: care pathway; integrated care; non-invasive risk screening; perinatal health; pregnancy; risk assessment