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Background: Adolescent pregnancies represent a significant global health challenge, with increased risks of maternal and neonatal complications. Traditional obstetrical risk assessment tools have limited applicability in this population due to unique physiological and anatomical characteristics. This study aimed to develop and validate novel predictive scores specifically designed for obstetrical risk stratification in adolescent pregnancies. Methods: A retrospective study was conducted over seven years (2018–2024) in Brasov County, Romania, including 1322 adolescent pregnancies (ages 12–16 years). Two novel predictive scores were developed: the Cervical Ripening Ultrasound Index (CRUI) for predicting successful vaginal delivery and labor induction, and the ADOLESRISK score for comprehensive obstetrical risk stratification. Statistical analysis included logistic regression, ROC curve analysis, and validation testing using SPSS 26.0 and R Studio version 4.3.2. Results: The CRUI score demonstrated superior predictive performance (AUC = 0.87, 95% CI: 0.84–0.90) compared to traditional Bishop score (AUC = 0.62, 95% CI: 0.58–0.66) for successful labor induction in adolescents. The ADOLESRISK score achieved 84% sensitivity and 76% specificity for predicting major obstetrical complications, significantly outperforming conventional risk assessment tools. Key risk factors incorporated included maternal age, educational level, nutritional status, and specific ultrasound parameters. Internal validation using train–test split methodology (70–30%) confirmed robust performance in the independent validation cohort (n = 397), with maintained discriminative ability (CRUI: AUC = 0.85, 95% CI: 0.80–0.90; ADOLESRISK: AUC = 0.82, 95% CI: 0.77–0.87) across different demographic subgroups. Conclusions: The CRUI and ADOLESRISK scores represent significant advances in adolescent obstetrical care, providing clinicians with tools for personalized risk assessment and management. Implementation of these scores could potentially reduce maternal complications by 25–30% and improve neonatal outcomes by 20–25%, representing a major contribution to adolescent reproductive health globally. Full article