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Active 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

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Objective

The purpose of this study was to determine whether exposure to an alternative method of care, called the active management of risk in pregnancy at term, was associated with a lower group cesarean delivery rate.

Study design

Active management of risk in pregnancy at term used risk factors for cesarean delivery to guide an increased use of labor induction. A retrospective cohort design was used to compare clinical outcomes of 100 pregnant women who were exposed to active management of risk in pregnancy at term to 300 randomly selected subjects who received standard management.

Results

The 2 groups had comparable levels of prenatal risk. The group exposed to the active management of risk in pregnancy at term exposure group encountered a higher induction rate (63% vs 25.7%; P < .001) and a lower cesarean delivery rate (4% vs 16.7%; P = .01). Findings were similar for both nulliparous and multiparous subgroups. Active management of risk in pregnancy at term exposure was not associated with higher rates of other major birth outcomes.

Conclusion

Exposure to the active management of risk in pregnancy at term exposure was associated with a significantly lower group cesarean delivery rate. A prospective randomized trial that involved active management of risk in pregnancy at term exposure is needed to further explore this association.

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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