Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-15T09:54:39.108Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of Different Systems for Classifying the Population at Risk

Published online by Cambridge University Press:  10 March 2009

Ubaldo Farnot
Ubaldo Farnot
Affiliation:
Hospital América Arias
Get access Rights & Permissions [Opens in a new window]

Extract

When a National Health System was established in Cuba and the health services regionalized, three levels of increasing complexity were established for prenatal care. This led to the use throughout the country of a system for the classification of pregnant women according to risk.

The first system used in 1969 was a qualitative system which divided pregnant women into 4 risk groups. This made it possible to establish levels and standards of care, to supervise and control the quality of prenatal care, and to use nurse-midwives for providing prenatal care efficiently. This very expeditious and practical system seemed somewhat inadequate because it gave little attention to biological and social factors, but stressed the complications of pregnancy and concomitant diseases.

Beginning in 1975, another system was used throughout the country to classify pregnant women during prenatal care. In this quantitative risk classification, an arbitrary value was given to each risk factor, and when these values were added up, the final score made it possible to divide pregnant women into 4 risk categories. This new system was also used for the administration of maternal and child health, but its use resulted in too many pregnant women being put into the high-risk category and many protective measures being taken for pregnant women who possibly did not need them. Validation tests such as sensitivity, specificity, and predictive power were used in this system, and it was found that it suffered from problems in discriminating the risk groups.

The need for a system of classifying pregnant women according to risk led to an epidemiological study whose purpose was to give a more appropriate numerical value to each risk factor. It is also emphasized that the objectives of prenatal care include not only the preventive treatment of diseases of women and children, but also the preparation of women for delivery, encouragement of breast feeding, and preparation of couples for assuming their responsibility as parents.

Type
The Technology of Prenatal Care
Information
International Journal of Technology Assessment in Health Care , Volume 1 , Issue 4 , October 1985 , pp. 821 - 831
Copyright
Copyright © Cambridge University Press 1985

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Lajonchere, Alvarez C. Atención prenatal. In Investigatión Perinatal. Havana: Científico-Técnica, 1981, 24.Google Scholar
2.Baird, D. & Thomson, A. M. Reduction of perinatal mortality by improving standards of obstetrical care. In Perinatal problems. London: E. and S. Livingstone Ltd., 1969.Google Scholar
3.Butter, N. R. & Bonham, D. G.Perinatal mortality. London: E. and S. Livingstone Ltd., 1963.Google Scholar
4.Moreno, Castell J. et al. Nueva Clasificación ARO para la profilaxis de la morbimortalidad maternofetal. Revista Cubana de Obstetricia y Ginecología, 1976, 2, 299.Google Scholar
5.Farnot, U. Cuidados intraparto. In Investigación Perinatal. Havana: Científico-Técnica, 1981, 60.Google Scholar
6.Farnot, U. et al. Estudio de los factores de riesgo obstétrico en las gestantes cubanas. In press.Google Scholar
7.García-Marruz, S. Clasificación del alto riesgo obstétrico-ARO. Havana: Provincial de Salud Pública (pamphlet for internal distribution), 1968.Google Scholar
8.Gold, E. M.Identification of the high-risk fetus. Clinical Obstetrics and Gynecology, 1968, 11, 1069–80.CrossRefGoogle ScholarPubMed
9.Goldstein, H. High risk predictors at booking and in pregnancy. Statistical Appendix to Chapter 3. In Perinatal problems. London: E. and S. Livingstone Ltd., 1969.Google Scholar
10.Goodwin, J. W. & Dunne, J. T.Antepartum-identification of the fetus at risk. Canadian Medical Association Journal, 1969, 101, 458.Google ScholarPubMed
11.Haeri, A. et al. A scoring system for identifying pregnant patients with a high risk of perinatal mortality. Journal of Obstetrics and Gynecology of the British Common wealth, 1974, 81, 535–38.CrossRefGoogle ScholarPubMed
12.Liisberg, E. Résumé of ongoing activities in risk approach in MCH case in WHO (pamphlet for internal distribution), 1979.Google Scholar
13.Mercier, G. & Desjardin, P.Evaluation numerique du risque pendant la grossesse. L'Union Medicale du Canada, 1973, 102, 102–06.Google Scholar
14.Nesbitt, R. E. L. & Aubry, R. H.High risk obstetrics II. Value of semiobjective grading system in identifying the vulnerable group. American Journal of Obstetrics and Gynecology, 1969, 103, 972–85.CrossRefGoogle ScholarPubMed
15.Rimoli, R.Embarazo de alto riesgo en función del pronóstico fetal. Obstetricia y Ginecología Latino Americanas, 1972, 30, 255.Google Scholar
16.WHO. A WHO Report on Social and Biological Effects on Perinatal Mortality. Vol. 1. Budapest: Statistical Publishing House, 1978.Google Scholar