Clinical application of a high-risk scoring system on a family practice obstetric service.

A previously described antepartum risk-scoring system was evaluated in 113 consecutive deliveries done by family physicians to determine whether a request for obstetric or pediatric assistance could be predicted. In the defined low-risk group (score less than or equal to 3) assistance was requested in 12 of 72 patients. In the defined high-risk group (score greater than 3) assistance was requested in 23 of 41 patients. Out of 28 requests for obstetric assistance, 22 requests were for a specific skill (cesarean sections, difficult forceps, premature deliveries, shoulder dystocia, and retained placenta). All of the 27 requests for pediatric assistance were for acute resuscitation of the newborn. Reinforced in this study was the finding that a relatively small segment of patients (36 percent of the population) gave rise to most (67 percent) of the morbidity. Knowledge of this simple, reliable method to predict high-risk obstetric patients should help family physicians reduce maternal and infant morbidity.