A simplified intrapartum numerical scoring system. The prediction of high risk in labor.

An analysis of 1,994 consecutive parturient women showed that 472 (23%) could be assigned to a high-risk category on the basis of an intrapartum score of greater than or equal to 3. Perinatal mortality, neonatal morbidity, and the rate for operative intervention were all significantly greater for the high-risk group (p < 0.0001). Of the total population, 11% were designated to be at high risk by combining intrapartum and antepartum scores, and 71% of this group had an abnormal intrapartum outcome (p < 0.0001). For this study, 63% of the patients with an abnormal outcome for labor were admitted to the labor floor for 6 hours or longer, and this is an indirect measurement of the potential that exists for optional management. The limitations of intrapartum scoring systems are discussed, particularly with respect to their design, the prediction of preventable deaths, and the category of hospital for which they might prove most useful.