Editors' ChoiceActive management of risk in pregnancy at term in an urban population: An association between a higher induction of labor rate and a lower cesarean delivery rate
Section snippets
Material and methods
The study involved two groups selected from women who delivered between January 1998 and May 2001 at the Hospital of the University of Pennsylvania, an urban university teaching hospital. The first group, called the AMOR-IPAT–exposed group (the exposed group), was composed of 100 sequentially delivered subjects who met inclusion and exclusion criteria and who received their prenatal care from physicians who used the AMOR-IPAT method of care. These subjects came from 3 different family medicine
Results
Table I lists the levels of demographic, past medical, past obstetric, and prenatal variables that were present in the 2 study groups. Of the 24 types of variables that were identified, 8 variables were present at similar levels (P > .30). Of the variables that were present that had significantly different levels (9 variables), or that trended towards different levels (7 variables), only 7 variables were associated significantly with or trended towards a significant association with cesarean
Comment
This study demonstrates a significant association between exposure to a high group labor induction rate and a low group cesarean delivery rate. Although this finding is not consistent with many previous studies,18., 19., 20. the AMOR-IPAT method of care used a high rate of both elective induction and cervical ripening within the context of a preventive strategy.14 This study also approached the study of the association between labor induction and cesarean delivery in a 2 unique ways. First,
Acknowledgments
We acknowledge Kelly Delaney, Dr Reva Edelstein, Dr Melissa Martinez-Guzman, and Matthew Simon for their assistance with data entry; Dr David Stamilio and Dr Michelle Berlin for their assistance with initial study design; and Dr Russell Localio for his assistance with analytic strategy. Dr Nicholson is currently supported by NIH/NICHD Grant 1K23 HD042043-01.
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