The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery

Nicholson, James M.; Kellar, Lisa C.; Kellar, G. M.

doi:10.1038/sj.jp.7211528

Cited by 46 publications

(42 citation statements)

References 22 publications

(30 reference statements)

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“…AMOR-IPAT involves 2 components: the use of preventive labor induction to increase the likelihood that each woman gives birth within her optimal time of delivery, and the use of PGE 2 to ensure that adequate cervical ripening occurs before preventive labor induction. 11,15,16 With this new method of care, cesarean delivery rates were lower in the nulliparous, multiparous, and previous cesarean delivery subgroups. The overall association between AMOR-IPAT exposure and lower cesarean delivery rate remained statistically signifi cant after adjustment for multiple potential confounding covariates and for the potential impact of clustering inherent in our study design.…”

Section: Discussionmentioning

confidence: 97%

“…Because the 2 main indications for primary cesarean delivery-cephalopelvic disproportion and uteroplacental insuffi ciency-increase as a function of increasing gestational age during the term period of pregnancy, 12 and because the effect of increasing gestational age on cesarean delivery is exacerbated by the presence of specifi c obstetric risk factors for cephalopelvic disproportion and uteroplacental insuffi ciency, 13,14 the optimal time of delivery varies depending on each woman's individual risk profi le. 15 If spontaneous labor does not develop before the upper limit of each woman's optimal time of delivery, then AMOR-IPAT uses preventive induction to ensure that delivery occurs within the optimal time of delivery. The estimation of each woman's upper limit of the optimal time of delivery is directly related to the number and nature of her obstetric risk factors (see Supplemental Appendixes 1 and 2, available onlineonly at http://www.annfammed.org/cgi/content/ full/5/4/310/DC1).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Preventive Approach to Obstetric Care in a Rural Hospital: Association Between Higher Rates of Preventive Labor Induction and Lower Rates of Cesarean Delivery

Nicholson

Yeager²,

Macones

2007

The Annals of Family Medicine

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PURPOSE Annual cesarean delivery rates in North America are increasing. Despite the morbidity associated with cesarean delivery, a safe preventive strategy to reduce the use of this procedure has not been forthcoming. During the 1990s, clinicians in a rural hospital developed a method of care involving prostaglandin-assisted preventive labor induction. An inverse relationship was noted between yearly hospital rates of labor induction and cesarean delivery. The purpose of our study was to compare cesarean delivery rates between practitioners who often used preventive induction and practitioners who did not, while controlling for patient mix and differences in practice style.METHODS Between 1993 and 1997, different hospital practitioners used riskguided prostaglandin-assisted preventive labor induction with differing intensity. We used a retrospective cohort design, based on the practitioner providing prenatal care, to compare birth outcomes in women exposed to this alternative method of care with those in women not exposed. Multiple logistic regression analysis controlled for patient characteristics and clustering by practitioner. RESULTSThe exposed group (n = 794), as compared with the nonexposed group (n = 1,075), had a higher labor induction rate (31.4% vs 20.4%, P <.001), a greater use of prostaglandin E 2 (23.3% vs 15.7%, P <.001), and a lower cesarean delivery rate (5.3% vs 11.8%, P <.001). Adjustment for cluster effects, patient characteristics, and the use of epidural analgesia did not eliminate the signifi cant association between exposure to this preventive method of care and a lower cesarean delivery rate. Rates of other adverse birth outcomes were either unchanged or reduced in the exposed group. CONCLUSIONS A preventive approach to reducing cesarean deliveries may be possible. This study found that practitioners who often used risk-guided, prostaglandin-assisted labor induction had a lower cesarean delivery rate without increases in rates of other adverse birth outcomes. Randomized controlled trials of this method of care are warranted.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

A Preventive Approach to Obstetric Care in a Rural Hospital: Association Between Higher Rates of Preventive Labor Induction and Lower Rates of Cesarean Delivery

Nicholson

Yeager²,

Macones

2007

The Annals of Family Medicine

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“…2,3,4 However, more recent data finds that pregnancy complications, as well as risk of cesarean delivery, increase beyond 40 and 41 weeks of gestation. 5,6,7 One of the reasons for the differences seen between the older and more recent data may be due to improved pregnancy dating since the advent of real time ultrasound. 8 It has been demonstrated that improved pregnancy dating leads to fewer women being identified as having postterm pregnancies or requiring induction of labor.…”

Section: Introductionmentioning

confidence: 99%

First- vs second-trimester ultrasound: the effect on pregnancy dating and perinatal outcomes

Caughey¹,

Nicholson²,

Washington³

2008

American Journal of Obstetrics and Gynecology

136

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Objective-To examine the effect of first trimester obstetric ultrasound (OBUS) on the measurement of the effect of complications ascribed to postterm pregnancies.Study Design-We conducted a retrospective cohort study of all term, singleton pregnancies delivered at our institution who had an OBUS at ≤24 weeks of gestation. Those women who underwent an OBUS at ≤12 weeks of gestation (OBUS12) were compared to those who had an OBUS at 13-24 weeks of gestation (OBUS13-24). The primary outcome measures were the rates of postterm pregnancies greater than 41 or 42 weeks' gestation. Secondary outcomes were the differences between the postterm and term gestations in maternal and neonatal outcomes.Results-In the OBUS12 group, the rate of postterm pregnancy ≥42 weeks was lower (2.7%) as compared to the OBUS13-24 group (3.7%, p=0.022). With regards to reaching 41 weeks of gestation, the OBUS12 group was again lower (18.2%) as compared to the OBUS13-24 group (22.1%, p<0.001). There were also fewer postterm inductions at ≥42 weeks in the OBUS12 group (1.8%) as compared to the OBUS13-24 group (2.6%, p=0.017). When comparing perinatal outcomes between those women who reached 41 weeks of gestation and those prior to 41 weeks of gestation, the OBUS12 group demonstrated greater differences between these two groups.Conclusion-Our findings suggest that earlier obstetric ultrasound, which leads to better pregnancy dating, reduces the rate of estimated postterm pregnancies. This may, in turn, reduce unnecessary intervention and lead to better identification of postterm pregnancies at greater risk of complications. Condensation: Women with first trimester ultrasounds are diagnosed with postterm pregnancies and experience postterm induction less often than those with a second trimester ultrasound. Keywords

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“…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]. Pregnant women at term who do not develop spontaneous labour as they near their UL-OTD are offered induction of labour (IOL).…”

Section: Introductionmentioning

confidence: 99%

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

Boca¹,

Biffi²,

R³

et al. 2017

Med Res Innov

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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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The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery

Cited by 46 publications

References 22 publications

A Preventive Approach to Obstetric Care in a Rural Hospital: Association Between Higher Rates of Preventive Labor Induction and Lower Rates of Cesarean Delivery

A Preventive Approach to Obstetric Care in a Rural Hospital: Association Between Higher Rates of Preventive Labor Induction and Lower Rates of Cesarean Delivery

First- vs second-trimester ultrasound: the effect on pregnancy dating and perinatal outcomes

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

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