Differentiation of women into low- and high-risk for complications during labor
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Objective: To ensure that women receive adequate care during labor, women are classified according to risk, low- or high-risk. Classification is carried out on admission to the maternity unit, and risk is continuously evaluated during labor. We studied the assessment performed by midwives in a maternity ward, and then reclassified the women in risk groups by strict following the guidelines. The objective of our study was to evaluate whether the guidelines were followed in clinical practice, both on admission to the hospital and during labor. We also studied whether mode of delivery and outcome for mother and child were related to correct risk assessment. Subjects and method: This was a retrospective descriptive study of 686 women who gave birth at St. Olavs Hospital in July and October 2016. We collected information of the midwife`s classification into low- and high-risk groups, both on admission to the hospital and during labor, using medical records. Then all of the women were reclassified according to the guidelines for differentiation on admission. Among women correctly classified as low-risk (n=269) by the midwives, we followed the course of labor. Information on whether the midwives had documented change in risk group during labor was registered. At last, the women were reclassified according to the guidelines for change in risk during labor. Results: Seventeen percent of the women had incorrect risk assessment on admission. Twelve percent were not classified at all. Of the women who had a correct low-risk classification on admission, 46.1% had incorrect risk assessment during labor. Conclusion: Clinical risk assessment, both on admission and during labor, was to a large extent incorrect. The risk of several women was not documented, neither on admission nor during labor. The course and outcome of labor were associated with correct risk assessment. The rate of operative delivery was lower among newborns of women correctly classified lowrisk on admission compared to those who were misclassified low-risk. Apgar-scores were higher among newborns of women that correctly stayed low-risk during labor compared to those who were misclassified low-risk. If a midwife-led care unit is implemented in our department, improvements in risk assessment are needed in order to know the correct proportion of low- and high-risk.