Antipartum surveillance by scoring system for pregnancy outcome of cesarean section in a tertiary referral centre of Madhya Pradesh, India

Sapna B. Jain, Rashmi Tripathi


Background: It is imperative to find out high risk pregnancy for providing apt care to the needy mother and fetus, so application of risk scoring system helps in pin pointing the at-risk patient and also gives a notion about the prognosis of fetal and maternal wellbeing. This study aims to evaluate the clinical application of risk scoring system in cesarean delivery for identification and management of risk pregnancies appropriately to improve perinatal and maternal morbidity and mortality.

Methods: LNMC Bhopal M.P. a tertiary referral centre with approximately 2100 delivery / year and cesarean rate of 33%, serving primarily rural population. This prospective analytical study conducted from July 2017 till June 2018. Focused on the combination of the principal predictors of obstetric outcome taken from the previously published scoring system were applied on 120 cases of unplanned at risk caesarean section and summed up to identify risk-pregnancy and its predictive value for maternal and perinatal outcome.

Results: It was determined by birth weight, APGAR score, birth asphyxia and NICU admission, Perinatal and maternal morbidity and mortality. Out of 120 caesarean cases 25% grouped in high risk, 58.3% low risk and 16.6%moderate group and their perinatal outcome was compared. 90% and 15% of the high risk and moderate group respectively had high risk neonates. In the high-risk group 2% had neonatal death, while no mortality in low risk cases. Maternal outcome was analysed by HDU admission 3% mothers were admitted in HDU with eclampsia and multi organ failure with one maternal mortality due to HELLP syndrome other recovered well, while one patient left against medical advice due to high expenses.

Conclusions: Risk evaluation by simplified scoring system is an easy and economical way to identify high risk pregnancy to provide quick, comprehensive and quality health services to needy mother and neonate at right time, thus help in lowering the perinatal and maternal mortality and morbidity even at PHC level.


Caesarian delivery HDU, HRP, High risk factors, Perinatal morbidity, Scoring system

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De A, De A, Fatima A, Sathian B, Asgil T, Finnegan R, Sharma JS. Prenatal risk score and pregnancy outcome: a study in Nepal. Res J Pharmaceut Bio Chem Sci. 2015 May 1;6(3):807-12

Honest H, Bachmann LM, Sundaram R, Gupta JK, Kleijnen J, Khan KS. The accuracy of risk scores in predicting preterm birth-a systematic review. J Obstet Gynaecol. 2004 Jun 1;24(4):343-59.

Papoutsis D, Antonakou A, Gornall A, Tzavara C, Mohajer M. The SaTH risk-assessment tool for the prediction of emergency cesarean section in women having induction of labor for all indications: a large-cohort based study. Arc Gynecol Obstetr. 2017 Jan 1;295(1):59-66.

Rijal P. Identification of risk factors for cesarean delivery following induction of labour. J Nepal Health Res Council. 2014;12(27):73-7.

Sowmya M, Dutta I. Comparative study of neonatal outcome in ceasarean section done in referred cases vs elective ceasarean delivery in a rural medical college hospital. J Evol Med Dental Sci. 2014 Nov 24;3(64):13993-9.

LeFevre M, Williamson HA, Hector JM. Obstetric risk assessment in rural practice. J Fam Pract. 1989 Jun;28(6):691-5.

Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, et al. Maternal complications and perinatal mortality: findings of the World Health Organization multicountry survey on maternal and newborn health. BJOG: Int J Obstetr Gynaecol. 2014 Mar;121:76-88.

Khunpradit S, Patumanond J, Tawichasri C. Development of risk scoring scheme for prediction of cesarean delivery due to cephalopelvic disproportion in Lamphun Hospital, Thailand. J Obstetr Gynaecol Res. 2007 Aug 1;33(4):445-51.

Sodsee S. Predicting caesarean section by applying nearest neighbor analysis. Procedia Computer Scince. 2014 Jan 1;31:5-14.

Khandale SN, Kedar K. Analysis of maternal mortality: a retrospective study at tertiary care centre. Int J Reprod Contracept Obstetr Gynecol. 2017 Mar 30;6(4):1610-3.

James DK, Steer PJ, Weiner CP, Gonik B. High risk pregnancy E-Book: Management options-expert consult. Elsevier Health Sciences; 2010 Dec 3.