Keirse M J
Department of Obstetrics, Leiden University Hospital, The Netherlands.
Am J Perinatol. 1989 Apr;6(2):226-33. doi: 10.1055/s-2007-999582.
Formal risk scoring systems for the prediction of preterm birth lack many of the characteristics that are required from effective screening tests. They show poor positive predictive values, poor reproducibility, and large differences in performance among different populations. In clinical practice the implementation of these scoring systems has not shown to confer more benefit than harm to the women and infants involved. There is no conclusive evidence for reduction of the incidence of preterm birth, especially among women considered to be at high risk on the basis of such scores. The use of these scores has led to a profusion of interventions being applied to women without demonstrable benefit for them from these interventions. The introduction of formal risk scoring for preterm birth thus profoundly alters the type of care available to pregnant women. The main effect thus far appears to be that a potential but relatively imprecise risk of preterm birth tends to be replaced by the certain risk of dubious treatments, whose merits are undocumented and whose hazards are unknown. There is great need for controlled studies to establish whether and for whom potential benefits of formal risk scoring can outweigh its hazards.
用于预测早产的正式风险评分系统缺乏有效筛查测试所需的许多特征。它们的阳性预测值较低，再现性差，并且在不同人群中的表现差异很大。在临床实践中，这些评分系统的实施并未显示出对所涉及的妇女和婴儿带来的益处多于危害。没有确凿证据表明早产发生率会降低，尤其是在基于此类评分被认为高危的妇女中。使用这些评分导致大量干预措施应用于妇女，但这些干预措施并未给她们带来明显益处。因此，引入早产的正式风险评分深刻改变了孕妇可获得的护理类型。迄今为止的主要影响似乎是，早产的潜在但相对不精确的风险往往被可疑治疗的确定风险所取代，这些治疗的优点未经证实，危害也未知。非常需要进行对照研究，以确定正式风险评分的潜在益处是否以及对哪些人而言能够超过其危害。
