A prospective hospital based st~~~· ~·!=s de s i gnArl T:n. evaluate the effectiveness of ANC - risk sc~ a ening in the four referral hospitals of Addis Ababa. The assessment of the effectiveness of the risk screening was performed by employing ANC card developed by the Family Health Department, MOH . A total of 758 mothers completed the study. 385 were high - risks and 373 were low risks. Among the 385 high risk mother, 232 were parous and 153 were nulliparous. Among the 385 high risk mothers; pregnancy related diseases 42%, malpresentation and malposi tion 30 . 6% and age 18.7% and non - pregnancy related diseases 9.6% were the main risk factors identified. Fifty six percent were having only one type of risk factor, 13.3% two and 30.4% three or more risk factor. 318 (42%) developed bad outcomes. Among these, 225 ( 71%) were identified as high risks during antenatal visit. Among the listed risk factors, current pregnancy related diseases (LR+6. 89, PVP 77.8%) , non-pregnancy related diseases (LR+ 5.53, PVP 73.5%), and malposition (LR + 4.76, PVP 71 . 2%) were found to have better discriminator and predictive powers of bad outcomes both in parous and nulliparous women. vii H~~ight in nulliparous (LR + 3.20, pvp 70 . :<%) a nCl a 'J~ in ooth groups (LR+ 2.80, PVP 67.1%) were found to oe fairly discriminant and predictive of bad outcome. Bad obstetrics history (LR+ 1.60, PVP 58.7%) and grand parity (LR+ 2.0, PVP 67.1%) were found to have less discriminating and productive capacity. Presence of 3 or more risk factor (LR + 22.3, PVP 92 . 3) followed by two factors (LR + 3.35, PVP 76.5%) were also found to have high discrimination and predictive capacity. The test performance of the ANC card was sensitivity 63.6%, specificity 70.8% LR + 1.95, PVP 58.4%). This instrument showed better performance in parous than in nulliparous. viii " APPEARANCES IN THE MIND ARE OF FOUR KINDS. THINGS EITHER ARE WHAT THEY APPEAR TO BE ; OR THEY NEITHER ARE, NOR APPEAR TO BE; OR THEY ARE, AND DO NOT APPEAR TO BE; OR THEY ARE NOT, YET APPEAR TO BE. RIGHTLY TO AIM IN ALL THESE CASES IS THE WISE HAN'S TASK. " EPICTETUS 2nd CENTURY AD