Antenatal risk screening and scoring: a new look.

At the individual level, risk assessment is fundamental to antenatal care. But at the program level, there are real difficulties associated with it, of which the most important is the false negatives - women with no (or few) risk factors who experience complications. This paper evaluates several commonly used indicators of risk in terms of both maternal (cephalopelvic disproportion) and fetal (low birthweight/prematurity) outcomes. The literature shows that obstetric history is a better measure of risk than so-called demographic variables like age and parity. When assessing the utility of a risk factor, Us sensitivity must be evaluated against the likelihood of false negatives. If risk assessment is practiced effectively, it must include a means of ensuring prompt treatment for low risk women with (unexpected) complications.