In the past, there has been considerable pessimism about our ability to identify the pregnant patient at risk. However, with the development of sophisticated diagnostic techniques these patients can be identified and with appropriate treatment their outcome can be improved. This paper presents the overall benefit of categorizing obstetrical patients, the method that has been developed at the Medical College of Virginia (MCV), and certain categories of high-risk obstetrical patients who continue to present problems and have unacceptably high complication rates