Objectives: To study the validity of the most common systems for evaluating obstetric risk in a random representative sample of pregnant Andalusian women.
Design: Crossover study of 1852 pregnancies of over 28 weeks and in which the women gave birth in the public hospitals of Andalusia (C.I. 95%, 7.5% accuracy). Information came from the maternity and neonatal clinical records and from a home visit after the birth. Sensitivity, specificity and predictive values of each cut suggested by the author in each system evaluated was calculated. Systems were compared with ROC curves.
Participants: Andalusian women who gave birth in public hospitals. Measurements and main results. Obstetric risk was evaluated with the Nesbitt and Aubry (ASMI), Hobel, Coopland and IROM indices, with the criteria used in Malaga West District, and Bull's proposals for English general practitioners. The validity of the predictions was studied for premature birth, low birth-weight, the CIR, hypoxia in the new-born, pathological birth and lengthy hospital stays of mother and child. The low predictive power of the indices studied was demonstrated. The best were the Hobel, Coopland and IROM indices. The indices had greater predictive power than the referral criteria: this, appreciating the different philosophies underlying the systems which, independently of their validity, determine the number of pregnant women at risk.
Conclusions: Since defining a pregnant woman as at risk is not innocuous, the research showed the importance of constructing systems, or at least validating existing ones, for the target community.