Factors associated with high-risk pregnancies in Canadian Inuit

Antenatal risk factors and management problems during labour and delivery were examined for 141 consecutive deliveries in Canadian Inuit of the eastern Arctic. The applicability of three risk scoring systems for antenatal use was evaluated. Pregnancies were categorized as being at high, moderate or low risk according to the authors' published criteria. Only two of the systems gave statistically valid predictions of the outcome of pregnancy in terms of risk categorization. Sensitivity and uniformity of the systems were lacking: the risk scores were low in 32% to 58% of the pregnancies in which the mother or the infant or both had problems during labour or delivery or both, and in 27% to 36% of the pregnancies in which the infant alone had problems. Antepartum factors that indicated a significantly increased risk of problems during labour or delivery or both were maternal age less than 16 or more than 35 years, prevous stillbirth or neonatal death, previous birth weight of less than 2501 g, previous pastpartum hemorrhage or other problem in the third stage of labour, antituberculosis therapy in the mother, and any of antepartum hemorrhage, multiple pregnancy, breech delivery, malpresentation or long period between rupture of the membranes and delivery in the current pregnancy. The data indicate that scoring systems should take into account regional or population variations if they are to have reasonable sensitivity.