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Use of Different Systems for Classifying the Population at Risk

Published online by Cambridge University Press:  10 March 2009

Ubaldo Farnot
Ubaldo Farnot
Affiliation:
Hospital América Arias
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Extract

When a National Health System was established in Cuba and the health services regionalized, three levels of increasing complexity were established for prenatal care. This led to the use throughout the country of a system for the classification of pregnant women according to risk.

The first system used in 1969 was a qualitative system which divided pregnant women into 4 risk groups. This made it possible to establish levels and standards of care, to supervise and control the quality of prenatal care, and to use nurse-midwives for providing prenatal care efficiently. This very expeditious and practical system seemed somewhat inadequate because it gave little attention to biological and social factors, but stressed the complications of pregnancy and concomitant diseases.

Beginning in 1975, another system was used throughout the country to classify pregnant women during prenatal care. In this quantitative risk classification, an arbitrary value was given to each risk factor, and when these values were added up, the final score made it possible to divide pregnant women into 4 risk categories. This new system was also used for the administration of maternal and child health, but its use resulted in too many pregnant women being put into the high-risk category and many protective measures being taken for pregnant women who possibly did not need them. Validation tests such as sensitivity, specificity, and predictive power were used in this system, and it was found that it suffered from problems in discriminating the risk groups.

The need for a system of classifying pregnant women according to risk led to an epidemiological study whose purpose was to give a more appropriate numerical value to each risk factor. It is also emphasized that the objectives of prenatal care include not only the preventive treatment of diseases of women and children, but also the preparation of women for delivery, encouragement of breast feeding, and preparation of couples for assuming their responsibility as parents.

Type
The Technology of Prenatal Care
Information
International Journal of Technology Assessment in Health Care , Volume 1 , Issue 4 , October 1985 , pp. 821 - 831
Copyright
Copyright © Cambridge University Press 1985

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References

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