Screening general obstetric populations for risk assessment. Who will need testing?

In spite of increasing emphasis on high-technology aids for antepartum screening, diagnosis, and care, the first steps to secure better outcomes for most pregnancies begin with basic preconception and early prenatal risk assessment. Although many well-studied tools are available for prospective care of the high-risk fetus, the impact of many maternal risk factors occurs prior to the time such approaches can be invoked. It is becoming more evident that preventive care may reduce or eliminate the toll exacted by some of the more frequent problems, such as poor nutrition, substance abuse, or failure to comply with effective regimens for treating common medical disorders. Schemes for reducing perinatal mortality place a premium on engaging the patient in her own risk management and early identification of problems. The role of patient education cannot be overemphasized. Making the pregnant woman an active member of her caretaking team is a good investment in time and effort.