Click here to return to our home page   Perinatal Review - Challenging Antenatal Care
Risk Scoring

NHS Logo

Risk Scoring
Which Intervention Work?

Back to Pregnancy Reviews


All studies so far discussed divided women into high or low risk groups based on previous obstetric and medical history. This has been examined further in several studies and each individual risk factor has been ascribed a numerical value in order to objectively determine a woman’s overall risk and label her as high or low risk accordingly. Some have tried to weight different risk factors but this has not so far been successful. In addition the significance off adding several small similar risks together to make a much larger risk has been questioned. Finally the question of timing has not been addressed. At the beginning of a pregnancy there is the maximum time to adjust pregnancy outcome but later on in pregnancy, events may alter a woman’s prior risk.

Although observational studies have suggested a reduction in premature deliveries as a result of this risk scoring, other studies have found that only 10-30% of those women labelled high risk actually experienced an adverse outcome (Reference1, Reference2, Reference3, Reference4, Reference5). Conversely between 20-50% of those women who deliver a preterm or small for gestational age infant, are low risk on prior scoring (Reference6).

Effective risk scoring also relies upon the ability to prevent or modify adverse outcome once it is identified. However, there are relatively few interventions proven to be of value in antenatal care.


1. Lilford R J, Chard T. Problems and pitfalls of risk assessment in antenatal care. British Journal of Obstetrics and Gynaecology.1983; 90: 507-510, Abstract

2. Keirse MNJC. Interaction between primary and secondary care during pregnancy and childbirth. In: Effective Care in Pregnancy and Childbirth. Editors: Chalmers I, Enkin M, Keirse MJNC. Oxford: Oxford University Press, 1989; pp197-201.

3. Hall MH. Identification of low risk and high risk. Bailliers Clinical Obstetrics and Gynaecology 1990; 4: 65-76, Abstract

4. Chard T, Learmont J, Caroll S, Hudson C, Lloyd DS, Sloan D. Evaluation of a fetal risk scoringsystem. American Journal of Perinatology 1992; 9: 388-393, Abstract

5. Shiono PH, Klebanoff MA. A review of risk scoring for preterm birth. Clinics in Perinataology. 1993; 20:107-125, Abstract

6. Enkin M, Keirse MJNC, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J. Risk scoring In: A guide to effective care in pregnancy and childbirth. Oxford: Oxford University Press, 2000; pp49-52.

Previous Page  

© Perinatal Institute 2011