Benefits of a Statewide High-Risk Perinatal Program

Heins, Henry C.; Miller, Joseph M.; Sear, Alan M.; Goodyear, Nancy; Gardner, Steve

doi:10.1097/00006250-198309000-00005

Cited by 9 publications

(8 citation statements)

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“…While the aforementioned studies concerning the safety of small maternity units and the competence of family physicians and nurse midwives are important to rural perinatology and to health planners, these institutions and providers cannot work in a vacuum. If any advances have been made in rural perinatology in the 1980s, these advances have coincided with the implementation of formal systems of regionalization of perinatal services (Gortmaker, Clark, Graven, Sobol, & Geronimus, 1987;Heins, Miller, Sear, Goodyear, & Gardner, 1983;Levy, Noelke, & Goldsmith, 1981;McCormick, Shapiro, & Starfield, 1985;Siegel, Gillings, Campbell, & Guild, 1985). These studies and others emphasize the positive impact that perinatal regionalization has had on maternal and neonatal outcomes, including the preven-tion of low birthweight and very low birthweight babies.…”

Section: Safety Of Low-volume Maternity Unitsmentioning

confidence: 99%

Children and Pregnant Women*

Lawhorne¹,

Zweig²,

Tinker³

1990

The Journal of Rural Health

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A review of the literature of the 1980s reveals that women living in rural American are at risk for receiving inadequate prenatal and maternal care. Documented risk factors include poverty and concomitant lack of medical insurance, residence in the most restrictive Medicaid states, and loss of local services including the closure of obstetric units of rural hospitals and the decision by local physicians to discontinue obstetrics. A prominent factor in a physician's decision to stop providing maternity care is the escalating cost of medical liability insurance; however, other forces are also at work, including interference with personal and family activities, disruption of other aspects of professional life (e.g., office schedule), inadequate reimbursement, and an inability to keep up with advancing technology. A research agenda for the 1990s should be consistent with previous recommendations and must stimulate the development of new programs that will induce the maximum number of providers to again offer high quality perinatal care to rural women. Other items on the 1990s research agenda include: (1) the clarification of the impact of lost perinatal services in rural areas, (2) the effects of travel time and distance on perinatal outcomes and cost of care, (3) the effect of loss of obstetric services on other health care services for women and children, and (4) comparisons of regionalized versus centralized systems for the provision of perinatal services.

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Section: Safety Of Low-volume Maternity Unitsmentioning

confidence: 99%

Children and Pregnant Women*

Lawhorne¹,

Zweig²,

Tinker³

1990

The Journal of Rural Health

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“…The accurate identification of patients requiring different levels of care is a major concern, for both the individual physician and the patient and in planning regional perinatal resources. A number of high-risk pregnancy scoring systems have been proposed, [1][2][3][4][5][6] but in general, information derived from them has not proved discernibly superior to expert clinical judgment. Many of the scoring forms are too extensive andcomplicated to be filled out by a busy clinician, without whose enthusiastic cooperation no screening system can ever be expected to function effectively.…”

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confidence: 99%

Antenatal Risk Scoring Form: Statistical Analysis of 1175 Cases

et al. 1989

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An antenatal risk scoring form was devised. The form contains 23 risk factors in three categories: reproductive history, associated medical conditions, and the present pregnancy. Numerical scores were arbitrarily assigned to each factor. The form was applied retrospectively to 1175 deliveries, and a total score was obtained for each case. The total score was related to perinatal death, preterm birth, Apgar score, and low birth weight. It was found that increasing score was significantly associated with poor outcome. The scores were grouped into low risk, high risk, and extreme risk. This system identified 25% of the study population as high and/or extreme risk, which in turn accounted for 94% of perinatal deaths. Although such a form in general has potential limitations and should not replace clinical judgment, its simplicity and demonstrated ability to assist in high-risk selection refines risk assessment for the experienced physician and quantifies it for the neophyte. It is recommended that the form be included in the prenatal records of all patients. Obstetricians have long recognized the need for varying levels of care. Pregnant patients with certain complications have an increased chance of having a complicated pregnancy course and an infant who has a complicated course; therefore,these patients require more intensive observation and care than usual. However, in our communities, well-trained personnel and resources are limited. The accurate identification of patients requiring different levels of care is a major concern, for both the individual physician and the patient and in planning regional perinatal resources. A number of high-risk pregnancy scoring systems have been proposed, 1-6 but in general, information derived from them has not proved discernibly superior to expert clinical judgment. Many of the scoring forms are too extensive andcomplicated to be filled out by a busy clinician, without whose enthusiastic cooperation no screening system can ever be expected to function effectively. In addition, not all of the known risk factors in pregnancy are universally applicable. It has been shown that some of the accepted risk factors may not have the

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“…13,17,18 A recent report with adequate control for confounding variables and wellselected controls demonstrated an increased risk of preterm delivery in patients with one or more previous abortions. 19 An interesting finding was that history of previous spontaneous abortion did not seem to impose a significant risk toward a poor outcome unless there were more than three previous spontaneous abortions.…”

Section: Discussionmentioning

confidence: 99%

Maternal Risk Factors and Outcome of Pregnancy in a Teaching Hospital in Riyadh

et al. 1989

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reviewed to investigate the association between various risk factors and pregnancy outcome. The study population was divided into two groups, a poor outcome group (group 1, n=249) and a good outcome group (group 2, n=926). The frequency of each of 29 variables in each group was obtained, and the significance of the difference was calculated using contingency table tests. Odds ratios and their 95% confidence limits were calculated for the 18 variables that were found to be significantly associated with poor pregnancy outcome. Some well-known risk factors in pregnancy, such as young maternal age, interval between pregnancies, previous infertility, previous large baby, previous uterine surgery, bleeding in early pregnancy, anemia, and post-datism, were not found to be significantly associated with a poor outcome. The findings in this study emphasize the fact that high-risk factors are not necessarily universally applicable. Few physicians would take issue with the importance of early recognition of high-risk pregnancy. Multiple factors are usually responsible for the overall outcome of pregnancy. The list of presumed or proved risk factors is quite long. The weight given to any individual risk factor varies with the geographic area, 1 ethnic group, and/or race.2,3 The purpose of this paper is to investigate the association between various risk factors and the outcome of pregnancy in a group of pregnant women in Riyadh, Saudi Arabia. Materials and MethodsThe 1175 deliveries occurring at King Khalid University Hospital from January 1983 through December 1984 provide the population for this study. Clinical details were coded from the hospital charts and entered into a microcomputer. Sixty-seven percent of the mothers were Saudi nationals, and 33% non-Saudis. Low-birth-weight rate was 8.2%. Preterm delivery rate was 6%. Sixteen perinatal deaths occurred in the study population. Eight percent of the mothers were 35 years of age or older and 12% were para 5 or more. About 4% of the patients had no prenatal care. No maternal deaths were recorded. During the 24-month study period, 62 mothers (5%) delivered twice. The unit of analysis was deliveries and not mothers.

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Benefits of a Statewide High-Risk Perinatal Program

Cited by 9 publications

References 0 publications

Children and Pregnant Women*

Children and Pregnant Women*

Antenatal Risk Scoring Form: Statistical Analysis of 1175 Cases

Maternal Risk Factors and Outcome of Pregnancy in a Teaching Hospital in Riyadh

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