Gynecology, Obstetrics and Perinatology

Current approach to perinatal risk stratification

Objective. To develop a new approach to perinatal risk stratification based on the determination of prognostic criteria for antepartum and intrapartum fetal death, and early neonatal death to improve the efficiency of predicting adverse perinatal outcomes.
Patients and methods. A retrospective case-control study with the participation of patients with antepartum (n = 134) and intrapartum (n = 41) fetal death, early neonatal death (n = 61), and favorable perinatal outcome (n = 50) was carried out. The Bayes–Wald–Gubler method was used to determine prognostic criteria. Comparative evaluation of the efficacy of the proposed prognostic method and the generally accepted determination of perinatal risk was performed retrospectively in patients with perinatal loss (n = 102) and favorable perinatal outcome (n = 100); ROC analysis was performed.
Results. Forty-two risk factors were identified and divided into three groups: universal for all types of perinatal loss, common for two of them, and specific for each of them (antepartum and intrapartum fetal death, early neonatal death). The prognostic value of factors in their presence and absence was determined. It was found that universal and common risk factors for each type of perinatal loss had different prognostic value. The method of differential prediction of perinatal loss was presented. The sensitivity of the new and generally accepted prognostic methods was 95.1 and 69.6%, the specificity was 80 and 53%, and the accuracy of predicting adverse outcomes was 87.6 and 61.4%, respectively.
Conclusion. The conducted study allowed to suggest a new approach to perinatal risk stratification based on differential prediction of perinatal loss, which is superior to the traditional risk assessment methods in terms of the effectiveness of predicting adverse perinatal outcomes.
Key words: antepartum fetal death, intrapartum fetal death, perinatal outcomes, prediction, early neonatal death
For citation: Suverneva A.A., Ignatko I.V. Current approach to perinatal risk stratification. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2021; 20(4): 69–77. (In Russian). DOI: 10.20953/1726-1678-2021-4-69-77

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