Malaysian antenatal risk coding and the outcome of pregnancy

Abstract

Objective: Measure the effectiveness of the colour coding system in Malaysia for the prediction of risk in pregnancy. Method: Cohort study of records and interviews of 253/279 women examined at first antenatal visit. Results: Nurses' final coding showed poor concordance with guidelines; recoding produced a predictive value of high risk of 48%; 25% of those with low risk had 50% of complications. Complication rates were moderate and intervention rates low. The mothers had little appreciation of risk and preferred home delivery. Home deliveries gave excellent results except for the 17% requiring transfer to hospital during labour or delivery. Conclusion: The coding system is ineffective with Malaysia's relatively low reproductive risk. Women require more personalised counselling about risk to make appropriate choices. Better results depend on simpler but consistent selection for hospital delivery using reproductive history, combined with better communication and transport systems for home deliveries and a reorientation within hospitals to rapid emergency care