Abstract
Objective
To evaluate the capacity of the current system of obstetric risk stratification at
the outset of pregnancy to predict severe adverse perinatal outcome.
Study Design
This retrospective cohort study of singleton pregnancies over a five year period (2009–2013)
was performed at the Rotunda Hospital, Dublin, Ireland. High-risk or low-risk status
was assigned retrospectively to a large consecutive cohort of women with a normally-formed
singleton pregnancy on the basis of factors analyzed at the first prenatal hospital
visit. The incidence of severe perinatal morbidity and mortality were compared between
high- and low-risk groups to determine the predictive utility of risk stratification
at the outset of pregnancy for severe perinatal morbidity.
Results
During the study period, 41,044 patients registered for prenatal care. 25,702;(63%)
were deemed low-risk and 15,342;(37%) high-risk. Low-risk women were statistically
more likely to be nulliparous (p < 0.0001) and to have a spontaneous or operative
vaginal delivery (p < 0.0001). High-risk women were more likely to be multiparous
and to undergo Caesarean delivery (p < 0.0001). The perinatal mortality rate was 3.8
per-1000 in low-risk pregnancies and 6.1 per-1000 in the a priori high-risk group
(p = 0.012). The incidence of severe neonatal encephalopathy (NNE) was 1.8 and 0.65
per-1000 in the low and high-risk groups respectively (p = 0.0025).
Conclusion
Where low-risk status is assigned at registration, neonatal encephalopathy is more
prevalent. This data is relevant for the design of prenatal care models and demonstrates
that assignment of low obstetric risk on the basis of maternal or pre-pregnancy factors
alone may erroneously be interpreted as conferring low-risk status to the fetus.
Keywords
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Article info
Publication history
Published online: June 05, 2018
Accepted:
June 5,
2018
Received:
April 8,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
