OB History Risk Factor |
Points |
Previous stillbirth |
10 |
Previous neonatal death |
10 |
Previous premature infant |
10 |
Post-term > 42 weeks |
10 |
Fetal blood transfusion for hemolytic disease |
10 |
Repeated miscarriages |
5 |
Previous infant > 10 pounds |
5 |
Six or more completed pregnancies |
5 |
History of eclampsia |
5 |
Previous cesarean section |
5 |
History of preeclampsia |
1 |
History of fetus with anomalies |
1 |
Medical History
Risk Factor |
Points |
Abnormal PAP test |
10 |
Chronic
hypertension |
10 |
Heart disease
NYHA Class II-IV (symptomatic) |
10 |
Insulin dependent
diabetes (> A2) |
10 |
Moderate to severe
renal disease |
10 |
Previous endocrine
ablation |
10 |
Sickle cell disease |
10 |
Epilepsy |
5 |
Heart disease
NYHA Class I (no symptoms) |
5 |
History of TB or PPD >= 10 mm |
5 |
Positive serology
(for syphilis) |
5 |
Pulmonary disease |
5 |
Thyroid disease |
5 |
Family History |
Points |
Family history of
diabetes |
1 |
Physical
Risk Factor Risk Factor |
Points |
Incompetent
cervix |
10 |
Uterine
malformations |
10 |
Maternal age 35 and over or 15 and under |
5 |
Maternal weight < 100 pounds or > 200 pounds |
5 |
Small
pelvis |
5 |
Current Pregnancy
Risk Factor |
Points |
Abnormal fetal
position |
10 |
Moderate to severe
preeclampsia |
10 |
Multiple pregnancy |
10 |
Placenta abruptio |
10 |
Placenta previa |
10 |
Polyhydramnios or
oligohydramnios |
10 |
Excessive use of
drugs/alcohol |
5 |
Gestational diabetes (A1) |
5 |
Kidney infection |
5 |
Mild preeclampsia |
5 |
Rh sensitization only |
5 |
Severe anemia < 9 g/dL hemoglobin |
5 |
Severe flu syndrome
or viral disease |
5 |
Vaginal spotting |
5 |
Bladder infection |
1 |
Emotional problems |
1 |
Mild anemia 9 g/dL hemoglobin |
1 |
Moderate alcohol
use |
1 |
Smoking >= 1 pack
per day |
1 |