| Pregnancy Risk Assessment |
|
Category
|
Risk Factors
|
Score*
|
|
Preexisting
|
|
Cardiovascular and renal disorders
|
Moderate to severe preeclampsia
Chronic hypertension
Moderate to severe renal disorders
Severe heart failure (class II–IV, NYHA classification)
|
10
10
10
10
|
|
History of eclampsia
History of pyelitis (infection of the renal pelvis)
Mild heart failure (class I, NYHA classification)
Mild preeclampsia
Acute pyelonephritis
|
5
5
5
5
5
|
|
History of cystitis
Acute cystitis
History of preeclampsia
|
1
1
1
|
|
Metabolic disorders
|
Insulin-dependent diabetes
Previous endocrine ablation
|
10
10
|
|
Thyroid disorders
Gestational diabetes
|
5
5
|
|
Family history of diabetes
|
1
|
|
Obstetric history
|
Fetal exchange transfusion because of Rh incompatibility
Stillbirth
Late abortion (16–20 wk)
Postterm pregnancy (> 42 wk)
Preterm neonate (< 37 wk and < 2500 g)
Intrauterine growth restriction (weight < 10th percentile for estimated gestational age)
Abnormal fetal position
Polyhydramnios (hydramnios)
Multifetal pregnancy
Previous brachial plexus injury
|
10
10
10
10
10
10
10
10
10
10
|
|
Neonatal death
Cesarean delivery
Habitual (≥ 3) abortion
Neonate > 4.5 kg
Shoulder dystocia
Multiparity of > 5
Seizure disorders or cerebral palsy
|
5
5
5
5
5
5
5
|
|
Fetal malformations
|
1
|
|
Other disorders
|
Abnormal cervical cytologic findings
Sickle cell disease
Thrombophilia
|
10
10
10
|
|
Positive serologic results for STDs
Severe anemia (Hb < 9 g/dL)
History of TB or purified protein derivative injection site induration ≥ 10 mm
Pulmonary disorders
|
5
5
5
5
|
|
Mild anemia (Hb 9.0–10.9 g/dL)
|
1
|
|
Anatomic abnormalities
|
Uterine malformation
Insufficient (incompetent) cervix
|
10
10
|
|
Small pelvis
|
5
|
|
Maternal characteristics
|
Age ≥ 35 or ≤ 15 yr
Weight < 45.5 or > 91 kg
|
5
5
|
|
Psychiatric disorder or intellectual disability (mental retardation)
|
1
|
|
Antepartum
|
|
Exposure to teratogens
|
Certain viral infections (eg, rubella, cytomegalovirus infection)
Flu syndrome (severe)
Excessive use of drugs
|
5
5
5
|
|
Smoking ≥ 1 pack/day
Alcohol (moderate to severe)
|
1
1
|
|
Pregnancy complications
|
Rh sensitization only
Vaginal spotting
|
5
5
|
|
Intrapartum
|
|
Maternal
|
Moderate to severe preeclampsia
Polyhydramnios (hydramnios) or oligohydramnios
Uterine rupture
Postterm (> 42 wk)
|
10
10
10
10
|
|
Mild preeclampsia
Premature rupture of membranes > 12 h
Preterm labor
Primary dysfunctional labor
Secondary arrest of dilation
Labor > 20 h
Second stage > 2.5 h
Medical induction of labor
Precipitous labor (< 3 h)
Primary cesarean delivery
Repeat cesarean delivery
|
5
5
5
5
5
5
5
5
5
5
5
|
|
Elective induction of labor
Prolonged latent phase
Oxytocin augmentation
|
1
1
1
|
|
Placental
|
Placenta previa
Abruptio placentae
Chorioamnionitis
|
10
10
10
|
|
Fetal
|
Abnormal presentation (breech, brow, face) or transverse lie
Multifetal pregnancy
Fetal bradycardia > 30 min
Prolapsed cord
Fetal weight < 2.5 kg
Fetal acidosis pH ≤ 7
Fetal tachycardia > 30 min
|
10
10
10
10
10
10
10
|
|
Operative delivery using vacuum extractor or forceps
Breech delivery, spontaneous or assisted
|
5
5
|
|
*A score of ≥ 10 indicates a high risk.
|
|
NYHA = New York Heart Association; STDs = sexually transmitted diseases.
|
) are assessed systematically because each risk factor present increases overall risk. High-risk pregnancies require close monitoring and sometimes referral to a perinatal center. When referral is needed, transfer before rather than after delivery results in lower neonatal morbidity and mortality rates. The most common reasons for referral before delivery are