J Nurs Acad Soc.  1983 Sep;13(1):7-21.

A Study on the Risk Factors for Maternal and Child Health Care Program with Emphasis on Developing the Risk Score System

• Lee KO

Abstract

For the flexible and rational distribution of limited existing health resources based on measurements of individual risk, the socalled Risk Approach is being proposed by the World Health Organization as a managerial tool in maternal and child health care program. This approach, in principle, puts us under the necessity of developing a technique by which we will be able to measure the degree of risk or to discriminate the future outcomes of pregnancy on the basis of prior information obtainable at prenatal care delivery settings. Numerous recent studies have focussed on the identification of relevant risk factors as the Prior infor mation and on defining the adverse outcomes of pregnancy to be dicriminated, and also have tried on how to develope scoring system of risk factors for the quantitative assessment of the factors as the determinant of pregnancy outcomes. Once the scoring system is established the technique of classifying the patients into with normal and with adverse outcomes will be easily de veloped. The scoring system Should be developed to meet the following four basic requirements. 1) Easy to construct 2) Easy to use 3) To be theoretically sound 4) To be valid In searching for a feasible methodology which will meet these requirements, the author has attempted to apply the "Likelihood Method", one of the well known principles in statistical anlysis, to develop such scoring system according to the process as follows. Step 1. Classify the patients into four groups: Group AI: With adverse outcomes on fetal (neonatal) side only. Group A2: With adverse outcomes on maternal side only. Group A3: With adverse outcome on both maternal and fetal (neonatal) sides. Group B: With normal outcomes. Step 2. Construct the marginal tabulation on the distribution of risk factors for each group. Step 3. For the calculation of risk score, take logarithmic transformation of relative proportions of the distribution and round them off to integers. Step 4. Test the validity of the score chart. A total of 2, 282 maternity records registered during the period of January 1, 1982-December 31, 1982 at Ewha Womans University Hospital were used for this study and the "Questionnaire for Maternity Record for Prenatal and Intrapartum High Risk Screening" developed by the Korean Institute for Population and Health was used to rearrange the information on the records into an easy analytic form. The findings of the study are summarized as follows. 1) The risk score chart constructed on the basis of "Likelihood Method" ispresented in Table 4 in the main text. 2) Prom the analysis of the risk score chart it was observed that a total of 24 risk factors could be identified as having significant predicting power for the discrimination of pregnancy outcomes into four groups as defined above. They are: (1) age (2) marital status (3) age at first pregnancy (4) medical insurance (5) number of pregnancies (6) history of Cesarean sections (7). number of living child (8) history of premature infants (9) history of over weighted new born (10) history of congenital anomalies (11) history of multiple pregnancies (12) history of abnormal presentation (13) history of obstetric abnormalities (14) past illness (15) hemoglobin level (16) blood pressure (17) heart status (18) general appearance (19) edema status (20) result of abdominal examination (21) cervix status (22) pelvis status (23) chief complaints (24) Reasons for examination 3) The validity of the score chart turned out to be as follows: a) Sensitivity: Group A1 : 0.75 Group A2: 0.78 Group A3: 0.92 All combined : 0.85 b) Specificity : 0.68 4) The diagnosabilities of the "score chart" for a set of hypothetical prevalence of adverse outcomes were calculated as follows (the sensitivity "for all combined" was used). Hypothetidal Prevalence : 5% 10% 20% 30% _40% 50% 60% Diagnosability : 12% 23% 40% 53% 64% 75% 80%.

MeSH Terms

Blood Pressure
Cervix Uteri
Cesarean Section
Child
Child Health*
Child*
Discrimination (Psychology)
Edema
Female
Health Resources
Heart
Humans
Infant, Newborn
Infant, Premature
Insurance
Marital Status
Pelvis
Pregnancy
Pregnancy Outcome
Pregnancy, Multiple
Prenatal Care
Prevalence
Risk Factors*
Sensitivity and Specificity
World Health Organization