Prenatal risk assessment and obstetric care in a small rural hospital: comparison with guidelines.

An assessment was made of the potential usefulness in a small rural hospital of the guidelines for prenatal risk assessment and management of the Newfoundland and Labrador Prenatal Record, a form similar to that in use in other provinces. A retrospective chart review was done for 266 pregnancies followed at the Baie Verte Peninsula Health Centre prior to the introduction of the guidelines. The pattern of practice was to request consultation and to transfer patients for delivery less often than was suggested by the guidelines; only 32% of patients at risk were assessed by an obstetrician. By the time of delivery only 39% of the patients were at no predictable risk according to the guidelines. Nevertheless, neonatal morbidity was present in this group (4% of the infants had an Apgar score of 6 or less at 1 or 5 minutes), though less often than in those at risk (18% of the infants had a low Apgar score). However, the group at no predictable risk required nonelective intervention in 40% of cases, approximately the same rate as that for the group at risk. It is necessary for some small hospitals to have the facilities and the trained staff to handle the problems that occur even in low-risk patients. To maintain the delivery rate necessary to retain skills, the guidelines may help family practitioners and consulting obstetricians to select some patients at risk who can be managed in small hospitals.