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General practitioner obstetrics: does risk prediction work?

J L Reynolds, P L Yudkin, M J Bull

    The Journal of the Royal College of General Practitioners
    |July 1, 1988
    PubMed
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    Antenatal risk prediction in pregnant women shows high transfer rates, particularly for first-time mothers. Maternal factors like weight and smoking influence transfer before labor, questioning outdated booking criteria.

    Area of Science:

    • Obstetrics and Gynecology
    • Maternal Health
    • Epidemiology

    Background:

    • Current antenatal booking criteria for risk prediction were established in the 1950s.
    • Evaluating the effectiveness of these historical criteria in contemporary obstetric practice is necessary.
    • Integrated general practitioner obstetric units manage a significant number of pregnancies.

    Purpose of the Study:

    • To assess the effectiveness of antenatal risk prediction using maternal characteristics at booking.
    • To identify maternal factors associated with transfer to consultant care before or during labor.
    • To evaluate the continued validity of 1950s-era booking criteria in modern obstetric care.

    Main Methods:

    • Retrospective analysis of 5730 pregnant women booked in an integrated general practitioner obstetric unit over seven years.

    Related Experiment Videos

  • Examination of maternal characteristics recorded at booking.
  • Analysis of transfer rates to consultant care and associated maternal factors.

    • Main Results:

    • High rates of transfer to consultant care were observed, especially among nulliparae (women who have not given birth).
    • Maternal factors significantly associated with transfer before labor included weight, smoking status, and social class.
    • Maternal stature and marital status were associated with transfer during labor; reasons for transfer were also identified.

    Conclusions:

    • Existing antenatal booking criteria, largely unchanged since the 1950s, demonstrate questionable validity in predicting obstetric care needs.
    • Maternal characteristics such as parity, weight, smoking, social class, stature, and marital status are important predictors of transfer.
    • Re-evaluation and updating of antenatal risk prediction and booking criteria are warranted to reflect current maternal populations and obstetric practices.