The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial

Am J Obstet Gynecol. 2008 May;198(5):511.e1-15. doi: 10.1016/j.ajog.2008.03.037.

Abstract

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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section / statistics & numerical data*
  • Female
  • Gestational Age
  • Humans
  • Intensive Care Units, Neonatal / statistics & numerical data
  • Labor, Induced / statistics & numerical data*
  • Odds Ratio
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Pregnancy
  • Pregnancy Outcome*
  • Pregnancy, High-Risk*
  • Proportional Hazards Models
  • Urban Population / statistics & numerical data