TY - JOUR
T1 - The impact of the active management of risk in pregnancy at term on birth outcomes
T2 - a randomized clinical trial
AU - Nicholson, James M.
AU - Parry, Samuel
AU - Caughey, Aaron B.
AU - Rosen, Sarah
AU - Keen, Allison
AU - Macones, George A.
PY - 2008/5
Y1 - 2008/5
N2 - Objective: The purpose of this study was to compare birth outcomes that result from the active management of risk in pregnancy at term (AMOR-IPAT) to those outcomes that result from standard management. Study Design: This was a randomized clinical trial with 270 women of mixed parity. AMOR-IPAT used preventive labor induction to ensure delivery before the end of an estimated optimal time of delivery. Rates of 4 adverse obstetric events and 2 composite measures were used to evaluate birth outcomes. Results: The AMOR-IPAT-exposed group had a similar cesarean delivery rate (10.3% vs 14.9%; P = .25), but a lower neonatal intensive care unit admission rate (1.5% vs 6.7%; P = .03), a higher uncomplicated vaginal birth rate (73.5% vs 62.8%; P = .046), and a lower mean Adverse Outcome Index score (1.4 vs 8.6; P = .03). Conclusion: AMOR-IPAT exposure improved the pattern of birth outcomes. Larger randomized clinical trials are needed to explore further the impact of AMOR-IPAT on birth outcomes and to determine the best methods of preventive labor induction.
AB - Objective: The purpose of this study was to compare birth outcomes that result from the active management of risk in pregnancy at term (AMOR-IPAT) to those outcomes that result from standard management. Study Design: This was a randomized clinical trial with 270 women of mixed parity. AMOR-IPAT used preventive labor induction to ensure delivery before the end of an estimated optimal time of delivery. Rates of 4 adverse obstetric events and 2 composite measures were used to evaluate birth outcomes. Results: The AMOR-IPAT-exposed group had a similar cesarean delivery rate (10.3% vs 14.9%; P = .25), but a lower neonatal intensive care unit admission rate (1.5% vs 6.7%; P = .03), a higher uncomplicated vaginal birth rate (73.5% vs 62.8%; P = .046), and a lower mean Adverse Outcome Index score (1.4 vs 8.6; P = .03). Conclusion: AMOR-IPAT exposure improved the pattern of birth outcomes. Larger randomized clinical trials are needed to explore further the impact of AMOR-IPAT on birth outcomes and to determine the best methods of preventive labor induction.
KW - adverse outcome index
KW - cesarean delivery
KW - neonatal intensive care unit admission
KW - preventive labor induction
KW - uncomplicated vaginal delivery
UR - http://www.scopus.com/inward/record.url?scp=42949094190&partnerID=8YFLogxK
U2 - 10.1016/j.ajog.2008.03.037
DO - 10.1016/j.ajog.2008.03.037
M3 - Article
C2 - 18455526
AN - SCOPUS:42949094190
SN - 0002-9378
VL - 198
SP - 511.e1-511.e15
JO - American journal of obstetrics and gynecology
JF - American journal of obstetrics and gynecology
IS - 5
ER -