BACKGROUND:
In 2017, an Icelandic inter-professional birth unit implemented a health and risk classification system to identify women’s care needs, creating an opportunity to examine the outcomes of low-risk women in a mixed-risk environment.

OBJECTIVES:
To compare birth outcomes in three study groups, defined by women’s need for midwifery-led or inter-professional care: 1) low-risk on admission; 2) low-risk on admission but reclassified due to emerging risk factors; 3) medium/high-risk on admission.

METHODS:
A prospective cohort study on electronic birth registry data on all women who gave birth in the birth unit in the first year after the implementation of the health and risk classification system, May 9, 2017 - May 8, 2018 (n = 2760). Subgroup analysis was performed for different reclassification indications, when present in the data (n = 864 of 881). Descriptive and unadjusted inferential statistics were presented, using SPSS.

RESULTS:
While half of women were low-risk on admission, only one in five was still low-risk at discharge (n = 531). BMI ≥30 and gestation ≥41 weeks increased the likelihood of reclassification. Perinatal mortality and low Apgar score rates were significantly higher among women with risk factors on admission (n = 1348). Women who were reclassified during labour (n = 881) had a significantly higher risk of interventions, maternal complications, and foetal distress. Reclassification due to medical pain relief (n = 576), treatment for prolonged labour (n = 72), and emerging health problems (n = 216), was related to significantly different outcome profiles.

CONCLUSIONS:
The outcomes of reclassified women are frequently worse than those of women with risk factors on admission and differ by reclassification indication. The study highlights the importance of discussions about women’s informed birthplace choices.

KEY MESSAGE:
Previously low-risk women with emerging intrapartum risk factors may benefit from improved care pathways in inter-professional settings. Poster session 2 (Group A)