The active management of risk in multiparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes

Abstract

Objective To determine if exposure of multiparous women to a high rate of preventive labor induction was associated with a significantly lower cesarean delivery rate. Study Design Retrospective cohort study involving 123 multiparas, who were exposed to the frequent use of preventive labor induction, and 304 multiparas, who received standard management. Rates of cesarean delivery and other adverse birth outcomes were compared in the two groups. Logistic regression controlled for confounding covariates. Results The exposed group had a lower cesarean delivery rate (aOR 0.09, 0.8% vs. 9.9%, p = 0.02) and a higher uncomplicated vaginal delivery rate (OR 0.53, 78.9% vs. 66.4%, p=0.01). Exposure was not associated with higher rates of other adverse birth outcomes. Conclusion Exposure of multiparas to a high rate of preventive labor induction was significantly associated with improved birth outcomes including a very low cesarean delivery rate. A prospective randomized trial is needed to determine causality.

The association between the regular use of risk-based term IOL and improved birth outcomes in an Italian hospital: A retrospective cohort study

“…Furthermore, the unusually low adjusted Odds Ratio (aOR) found for the association between "exposure" and CD rate (0.04) indicates the strong possibility of an underlying causal relationship [39]. Such a possibility is also suggested by the unusually strong aORs noted in previous AMOR-IPAT observational studies [24,[27][28][29][30].…”

“…However, a similar use of AMOR-IPAT in the setting of an RCT reported that AMOR-IPAT exposure led to a significantly lower NICU admission rate as compared to usual care. 30 In addition, all observational studies of AMOR-IPAT have included risk-based IOL in the early-term period (i.e., the 37 th of gestation) and all have reported either lower or unchanged rates of NICU admission following AMOR-IPAT exposure [18,20].…”

“…AMOR-IPAT begins with the assessment of each pregnancy's pattern of common prenatal risk factors. This assessment is then used to estimate, for each pregnancy, an upper limit of the optimal time of delivery (UL-OTD) [24,[28][29][30][31]. The greater a pregnancy's composite risk of CD for either cephalo-pelvic disproportion (CPD) or utero-placental insufficiency (UPI), the earlier the pregnancy's estimated UL-OTD [31].…”

“…Several published retrospective cohort studies described associations between exposure to an alternative method of care called the Active Management of Risk in Pregnancy at Term (AMOR-IPAT) and unusually low group CD rates (0.8% -11%) [24,[27][28][29][30]. AMOR-IPAT begins with the assessment of each pregnancy's pattern of common prenatal risk factors.…”

The Impact of Early Versus Late Amniotomy on Duration of Labor, Maternal and Neonatal Outcomes in Iraqi Primigravida with Spontaneous Labor

“…The rate of labor induction is increasing with time [8], and elective labor induction became more popular, and mostly associated with improved neonatal outcomes in certain circumstances. Accordingly, the overall rate of induction will unlikely decrease in the near future [9,10]. On the other hand, two to three fold increases in the risk of cesarean delivery was reported with induction of labor, and has contributed to the increase in cesarean rates over the last two decades [11].…”