A Systematic Review of Antenatal Risk Scoring Systems in India to Predict Adverse Neonatal Outcomes

Dinesh Raj Pallepogula; Adhisivam Bethou; Vishnu Bhat Ballambatu; Gowri Dorairajan; Ganesh Kumar Saya; Sureshkumar Kamalakannan; Sandhya Karra

doi:10.1007/s13224-021-01484-z

A Systematic Review of Antenatal Risk Scoring Systems in India to Predict Adverse Neonatal Outcomes

J Obstet Gynaecol India. 2022 Jun;72(3):181-191. doi: 10.1007/s13224-021-01484-z. Epub 2021 Jul 12.

Authors

Dinesh Raj Pallepogula¹, Adhisivam Bethou¹, Vishnu Bhat Ballambatu², Gowri Dorairajan³, Ganesh Kumar Saya⁴, Sureshkumar Kamalakannan⁵, Sandhya Karra⁶

Affiliations

¹ Department of Neonatology, JIPMER Puducherry, Puducherry, India.
² Department of Paediatrics, AVMC Puducherry, Puducherry, India.
³ Department of Obstetrics and Gynaecology, JIPMER Puducherry, Puducherry, India.
⁴ Department of Preventive and Social Medicine, JIPMER Puducherry, Puducherry, India.
⁵ PHFI, Indian Institute of Public Health - Hyderabad, India Alliance-DBT Wellcome Trust, Hyderabad, Telangana India.
⁶ Department of Surgery, JIPMER Puducherry, Puducherry, India.

Abstract

Background: The purpose of antenatal care (ANC) is to identify 'at-risk' pregnant women, to provide quality care for all, and maximize the allocation of resources for those who need them the most. To address the synergistic effect of risk factors, clinicians across the globe developed antenatal scoring systems.

Objective: This review aims to investigate various antenatal risk scoring systems developed and used in India to predict adverse neonatal outcome.

Methods: We reviewed articles published between January 2000 and April 2020, which have either developed a scoring system or used a scoring system, among the Indian population. This systematic review is reported based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Prediction model study Risk Of Bias Assessment Tool (PROBAST) was employed for the assessment of the quality of included studies. Data sources such as Embase, MEDLINE/Pubmed, APA PsycExtra, PsycINFO, CINHAL Plus, Cochrane Library, IndMED, LILACS, Scopus, WHO Reproductive Health Library and Web of science were searched.

Results: An initial search retrieved a total of 6246 articles. This systematic review identified six studies, of which one study developed an antenatal scoring system and the other five studies used two antenatal systems for predicting adverse neonatal outcome. The study which developed a risk scoring system had a high risk of bias (ROB) and concern for applicability. The overall sensitivity of the antenatal scoring system was high (77.4%), but the specificity was low (45%). Similarly, the positive predictive value is low (15.3%), and the negative predictive value is high (94.2%). A meta-analysis was not conducted due to the heterogeneity of the studies and insufficient data.

Conclusions: There is a need for a systematically developed antenatal scoring system for India. Such scoring systems can be promising in public health, proposing a paradigm shift in the implementation of effective mother and child health programmes locally as well as nationally.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-021-01484-z.

Keywords: Antenatal risk scoring; High-risk pregnancy; India; Risk score development; Systematic review.

Publication types

Review