Pregnancy is special and let us make it safe. High-risk pregnancy¹ is one in which the foetus and mother are vulnerable to significant risk of morbidity and mortality. In a country like ours with scanty resources, it is essential that extra care be provided to only those who deserve it most. This can be done by early identification of risk factors.

Risk scoring system is a formulated method of recognising, documenting and cumulating antenatal and intranatal factors to identify high-risk pregnancies and predict complications for the mother, foetus and infants. Every year, half a million women die due to direct pregnancy-related causes, 20 million suffer serious and long-lasting disabilities¹, 4 million new born and infants die and millions are disabled. Maternal and perinatal loss is the mirror of ‘Mother and Child Health’ services of a country. Once a pregnancy with complications is identified, the pregnant woman must reach a hospital with facilities necessary for taking care of such complications. Risk factors are characteristics that have a significant association with a defined end point, i.e. outcome for which each risk factor or a group of factors is sought. Apart from too young (<17years), too old (>35years), too many (>4 children) and too close (gap <2years between two deliveries), the high-risk patients are those who by virtue of their complications need individualised special care. About 70% of cases remain unbooked because facilities for perinatal care are too far from pregnant woman's residence and they are never useful because of two reasons: (1) women are reluctant to take time off from their household work and (2) it is costly to travel long distance for regular care.

A case-control study was conducted at the Rabindra Nath Tagore Medical College and Hospital, Udaipur, between January and December 2005 among 400 pregnant women of gestational age 28 weeks or more who reported to the labour room.

They were grouped into study (A) (score>9) and control (B) (score<9) groups according to the Coopland et al.² and Daga and Daga³ scoring systems modified according to local needs. A total of 19 factors were studied, as given in Table 1.

Patients who were admitted to the labour room but were discharged without delivery were excluded. Patients were divided into two groups as given below in Table 2. Patients were reviewed for foetal outcome in the terms of birth weight, Apgar score and perinatal deaths and for maternal outcome in the terms of mode of delivery and PPH, and the data were analysed by chi square test

Patients were divided into two groups, namely, high risk (A) and low risk (B) groups, with 200 patients in each group.

Maximum population belonged to the 17–30 years age group.

A high score of 3 was given to emergency patients in Table 4.

Parity varied from 0 to 8.

In group A, 39% of the patients had poor obstetric history.

A total of 17% of the population in group A had medical disorders in Table 7.

In 82.5% cases, antepartum complications were present in group A.

In the high risk score group of previous studies, incidence of perinatal mortality⁵ was 100%, for birth asphyxia⁶ it was 85–88% and for low-birth-weight babies⁵ it was 82.5% which is comparable to the present study which had a 93.3% perinatal mortality, birth asphyxia risk of 79.16% and low-birth-weight baby risk of 77.27% in the high risk score group.

Incidence of vaginal deliveries in the high risk group was 56.19%, while in previous studies it was 69%. Incidence of PPH/MRP in the high risk group was 80.5%. As shown in the present study, there was increased number of complications with increased score, which was also shown by Ambiye et al.⁷

High risk contributed to major proportion of perinatal deaths (93.33%; P<0.001), low-birth-weight babies (P <0.001), asphyxiated baby (P<0.05), operative deliveries (P<0.001) and PPH (P<0.001), thereby ascertaining the reliability of scoring system in identification of mother and foetus at risk.

Previous studies by Fernandez et al.⁸, and Lopez and Deshmukh⁹ showed higher birth asphyxia in elderly and young mothers, higher low birth weight incidence and perinatal mortality (20.2%) in these mothers, respectively. Same is true in the present study. Perinatal mortality (27%) is comparable with the Rangnekar and Biswas¹⁰ study in unbooked patients. Incidence of operative deliveries (34.2%) was high in unbooked patients. Incidence of low birth weight (45.5%) and perinatal mortality (27.3%) increased with increased parity and so is the incidence of maternal complications in the form of PPH (18.2%). Foetal outcome was poor and operative deliveries were more in presence of poor obstetric history. Foetal and maternal complications were more in presence of medical diseases.

Low birth weight (30%), low Apgar (7.3%) and high perinatal mortality (15.3%) were seen in mothers having antepartum complications. Incidence of operative deliveries (34.2%) and PPH (10.3%) was high in the presence of antepartum complications.

Number of foetal and maternal complications was higher in elderly mothers, unbooked patients, grand multiparas, those from low socio-economic strata and mothers with antepartum complications, thus justifying need for higher score to these mothers.

From the study, it may be concluded that it is possible to identify mothers who were expected to contribute disproportionately to poor pregnancy outcome as a consistent trend was noted with higher score to yield the poorest obstetric results. Though obstetrics is very tricky and unpredictable, anytime a low risk case may turn up into high risk; still, by using risk scoring system, high risk cases prone to develop complications can be scrutinised.

MRP, manual removal of placenta; Risk evaluation score form created and modified according to local needs4.

MRP, manual removal of placenta.

MRP, manual removal of placenta.

MRP, manual removal of placenta.

MRP, manual removal of placenta.

MRP, manual removal of placenta.

MRP, manual removal of placenta.

*P<0.05 (S); **P<0.001 (H.S.)

*P<0.05 (Significant); **P<0.001 (Highly Significant.)

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