By Jo Alexander, Valerie Levy, Sarah Roch (eds.)
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Additional resources for Midwifery Practice: Core Topics 1
No score yet seems to incorporate the ideal combination of factors and statistical techniques. The problems are compounded when, as is likely, the women for whom the score is to be used have different characteristics from those of the population from which the score was derived (Chard 1991). For example, Hobel's score was developed from a study of women in Los Angeles (Hobel et at 1973), who are not necessarily representative of women in other places at other times. Consequently, many scores lack sensitivity, meaning that they miss many pregnancies that will become complicated, and specificity, that is, they include in the high-risk group many women who will have normal pregnancies and labours.
1 amongst those they consider to be risky. Some, like Reynolds et al (1988), would doubt whether the criteria of 1967, based on the Cranbrook Committee's recommendations of 1959 (Ministry of Health 1959), are still adequate as the basis on which women are booked for GP care. These criteria were that women should have uncompromised medical and obstetric histories, nulliparae should be taller than 152 cm and less than 30 years of age, and multiparae should be less than 35 years old and of parity less than four.
It uses six risk factors, combined by addition. Many scores have more specific aims. The score of Goodwin et al (1969) is considered to be among the best (Wall 1988; leFevre et al 1989) and aims to predict fetal death. The score of Creasy et al (1980) (a revised version of Papiernik's score: Papiernik-Berkhauer 1969) aims to evaluate the risk of premature labour, as does that of Ross et al (1986). This latter score is, however, 44 . Midwifery Practice: Core Topics 1 designed to be used at the time of birth and illustrates that some scores may have more epidemiological than predictive use.
Midwifery Practice: Core Topics 1 by Jo Alexander, Valerie Levy, Sarah Roch (eds.)