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The Beneficial Use of Risk Scoring in a Remote and High‐Risk Pregnant Population
Author(s) -
Humphrey Michael D
Publication year - 1995
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1995.tb01856.x
Subject(s) - medicine , perinatal mortality , audit , population , scrutiny , incidence (geometry) , singleton , pregnancy , infant mortality , demography , environmental health , sociology , biology , fetus , genetics , physics , management , optics , political science , law , economics
EDITORIAL COMMENT: We accepted this paper for publication because obstetric practice in this region of Australia is important and readers will be interested to see the results of an audit performed by the author and assessed with the scoring system that is described. It is well known that scrutiny improves performance though how this is achieved is often not clear. Readers will not be surprised that there was a higher perinatal mortality rate in the unscoredpatients which, according to our interpretation of the data presented, included all of the nonbooked patients. However the reduction in perinatal mortality, both in the Cairns Base Hospital and in the patients born outside Cairns over the time reviewed, is impressive. It is of interest to note that the perinatal mortality rate in the babies born outside the Cairns Base Hospital, where the scoring system was not practised, fell from 10.5 per 1,000 singleton births in 1991 to 5J per 1,000 in 1993, although this reduction does not quite reach statistical significance. Summary: The Peninsula and Torres Strait Health Region in Far North Queensland is a large and remote region with a high incidence of at‐risk pregnancies and few experienced caregivers to provide antenatal care. Pregnancy Risk Scoring was trialled as a means of best allocating meagre resources. All 3,679 women with singleton pregnancies who gave birth at Cairns Base Hospital were studied over a 30‐month period, during which time the Hospital and Regional perinatal mortality rates fell by more than 50%. Risk scoring was applied to 2,875 of these pregnancies. Preterm birth, the birth of low birth‐weight babies, and birth intervention were less likely to occur in those women with a low‐risk score, with the lower likelihood of preterm birth reaching clear statistical signficance. Where pregnancy care resources are scarce and large numbers of high‐risk pregnant women are scattered throughout a remote area it would appear that risk scoring assists positively with decisions about the best use of resources.