Prospective labor risk assessment in a rural community hospital

This prospective study investigates the utility of a labor risk assessment instrument for the prediction and management of the low Apgar infant in the community hospital setting. Two hundred and fifty patients in labor were managed with a protocol involving initial and ongoing risk assessment throughout the course of labor and delivery. Patients scored as high risk were independently assessed to determine the need for the presence of the resuscitation team at delivery. Twenty-one percent of infants of high-risk mothers required resuscitation, whereas only 8% of infants whose mothers scored as low or moderate risk required resuscitation. A modified ten factor list was developed using multiple logistic regression analysis and clinical experience. This was found to improve predictive power for low Apgar score infants in need of resuscitation within a risk group comprising only 27% of the population. We conclude that this intrapartum scoring system can be readily implemented in a community hospital and is effective in identifying high-risk infants so that resources can be mobilized for appropriate intervention.