[The concept of risk in perinatology. Results of epidemiologic surveys (author's transl)].

A national survey of pregnancy and childbirth was conducted in 1972 in France from which for the first time risk factors for all pregnancies and practical consequences for prevention were obtained. Risk factors were determined by multivariate analysis for stillbirth, prematury, and low birth weight infants. Two groups of women were found to be at higher than average risk. The first included those under 18 or over 40 years old, or having a history of previous stillbirth or infant with birth weight less than 2 500 g. The 13% of all pregnant women in this group had double the overall population rate of stillbirth, prematurity and low birth weight infants. The second group, 7% of all pregnant women, included widowed, divorced, and separated women, as well as immigrant workers or wives of immigrant workers. These two groups of women, as well as those with pathological findings during pregnancy should be more closely followed during pregnancy as specified by law. However, the survey showed that the surveillance of high risk pregnancies is on the whole inferior to that of the overall population. Several solutions have been proposed to remedy this situation: -- to double the number of obligatory prenatal examinations, to 10 per woman, for all pregnancies, which would double the present total number of prenatal examinations from 4 000 000 to 8 000 000; -- to apply the legislation to women with high risk pregnancies by increasing either the inducements (educating these women and their doctors, more reembursements of costs), or constraints (requiring more medical appointments, home visits, or financial sanctions).