Risk assessment at the end of pregnancy is a poor predictor for complications at delivery

Objective. To evaluate the usefulness of prenatal risk assessment for predi ction of need for obstetric interventions. Design. Area based retrospective study Setting Vasteras Central Hospital, Sweden, with all antenatal care units in the area. Subjects. All women delivered at the only delivery ward in the area, after attending antenatal care at the affiliated ANC-units in 1940 (n=2008) and 1 992 (n=1874)., Main outcome measures. Obstetric interventions at delivery. Results. During the two years 81% and 83% of the study population delivered an infant in vertex presentation ar term but 15%, and 17% without risk fac tors or complications at the end of pregnancy had complications during deli very. The relative risk for interventions when risk factors were present wa s 2.2 and with spontaneous onset of labor 1.3/1.4. Low risk primiparae had unforeseen complications in 25% and multiparae in 10%. Relative risk for mu ltiparae with risk factors and spontaneous labor was 2.2/1.8 and for primip arae 1.4/1.6. Conclusions. Individual prediction of obstetric emergencies has low accurac y, which should he included in the information to women as well as in discu ssions with health planners.