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Objective: Associations have been recently reported between the regular use of risk-based term labor induction and improvements in birth outcomes. We wanted to study the use of this approach in an Italian hospital. Design: Retrospective Cohort StudySetting: The Mandic Hospital, in Merate, Italy, from March 2009 through July 2010.Population: All pregnant women delivering at term who met study inclusion and exclusion criteria. Methods:The "exposed" group was comprised of women cared for and delivered by providers who regularly offered risk-based term labor induction. The "nonexposed" group was comprised of women cared for and delivered by providers who followed the "expectant management" approach to risk. Prenatal, intrapartum and outcome data for the two cohorts were collected and compared. Main outcome measures:Cesarean delivery rate and weighted Adverse Outcome Index (AOI) Score. Results:The exposed group (n=120), as compared to the non-exposed group (n=159), had a higher induction rate, a lower cesarean rate (1.7% vs. 43.4%, aOR 0.04, CI [0.01-0.22]), and a numerically lower weighted Adverse Outcome Index Score (0.4 vs. 6.1, p=0.61). Two cases of term stillbirth occurred in the non-exposed group. No adverse birth outcome occurred with greater frequency in the exposed group. Conclusion:In this Italian hospital, and consistent with previous studies, exposure to the regular use of risk-based term labor induction was associated with a more favorable set of birth outcomes. Randomised clinical trials are needed to further explore this alternative approach.

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