Risk assessment during pregnancy: A scoping review

Introduction: In the obstetric area, the influence of epidemiological risk, which has gained a great repercussion in the public health actions since the 1970s, associated with changes in the political and social context, resulted in significant changes in pregnancy and childbirth’s model of care. Examples include the transfer of childbirth from the home environment to the hospitals, an increase in the supply and use of diagnostic technologies, and adoption of prenatal care as a strategy to deal with the high rates of maternal and neonatal mortality. Following the influence of epidemiology of risk factors, prenatal care model began to incorporate the use of risk assessment during pregnancy (RAP). However, despite the increase in the antenatal care coverage in recent years, maternal morbidity and mortality still represent an important challenge for public policies, which may indicate the need to review the strategies adopted during the care of pregnant women.

Objective: To map the use of the risk assessment during pregnancy in the scientific literature.

Methodology: A scoping review was carried out following the framework proposed by Peters. In our protocol, we included qualitative and quantitative studies through a search in three different databases and in the gray literature. The Inclusion criteria were: development, use, and evaluation of RAP protocols. We found 2,625 articles and manuals, of which 237 were excluded because they were duplicated. The process of eligibility was carried out by two independent reviewers and the divergences were settled by consensus. After reading the titles, 480 documents were selected for the abstracts reading, resulting in 57 for the full appraisal, nineteen of which were later excluded. Data were extracted from 38 articles, and the documents were evaluated regarding the place of study, efficacy on assessing gestational risk, the maternal and/or perinatal outcomes, and whether RAP resulted in any impact on the gestational outcomes.

Results: Documents were classified into four thematic categories, and for those that fitted more than one, both were accounted. In the literature, RAP was discussed in relation to the creation of protocols (n = 13), comparison between different protocols (n = 5), protocol evaluation (n = 18) and discussion of its use and implications (n = 9). The vast majority of studies were conducted in high-income countries (n = 33). The included studies did not demonstrate a relationship between the use of RAP and the improvement of gestational and postnatal outcomes. Only one pilot study found an improvement in the prematurity rates, but the RAP tool was associated with other health interventions.

Conclusion: Protocols were very distinct and included a wide variety of risk factors, thus it is necessary to conduct studies to evaluate these instruments, analyzing their sensitivity and specificity, as well as the implementation process. The effectiveness of RAP in improving maternal and infant outcomes has not been proven. Therefore, although this approach is used, care during pregnancy should provide an opportunity for a woman-centred care approach, which can identify vulnerabilities and appropriated interventions.