Should Parity Be Included in Risk Assessment for Perinatal Complications?
BACKGROUND AND PURPOSE:
Generally, obstetric risk assessment is based on factors including
Maternal age | BMI | Preexisting comorbidities | Past obstetrical history
Parity is generally not considered an independent risk factor for identifying women at increased risk of complications that would lead to escalation to a higher level-of-care facility
Jardine at al. (BMJ, 2020), using current UK guidelines, sought to determine if pregnancy risk classification could be improved by stratifying based on parity and the number of risk factors
Women with a singleton birth at term following a trial of labor
Women classified according to the NICE guideline as being at low, intermediate, and increased risk at the time of birth
Rate of complications and interventions were calculated
Extent to which the risk classification could be improved was then determined based on
Number of risk factors between nulliparous women and multiparous women
With and without previous caesarean delivery
276,766 women were included
Multiparous women without a history of cesarean section had the lowest rates of complicated birth
Without specific risk factors: 8.8% (95% CI, 8.6 to 9.0%)
≥3 specific risk factors: 21.8% (95% CI, 20.2 to 23.4%)
Complicated birth rate was higher in nulliparous women
Without specific risk factors: 43.4% (95% CI, 43.0 to 43.8%)
≥3 specific risk factors: 64.3% (95% CI, 60.3% to 68.3%)
Rate of complicated birth was highest in multiparous women with a previous cesarean
Without specific risk factors: 42.9% (95% CI, 41.8 to 44.0%)
≥3 specific risk factors: 66.3% (95% CI, 63.0 to 69.5%)
In women without a previous cesarean, nulliparous women were at greater risk for complications than multiparous women
This was true even if the multiparous women had multiple risk factors
The authors suggest that risk assessment should be grouped by parity and previous mode of birth first, and then risk assessment performed within these groups according to presence of specific risk factors
In addition, the authors conclude
…nulliparous women, including those without additional risk factors, have considerably higher risks of a complicated birth, and they could consider giving birth in a setting that enables rapid access to care by an obstetric or neonatal team
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