Preventive Labor Induction Research Articles

The association between the regular use of early-term labor induction and improved birth outcomes: new evidence from an Italian hospital

Associations have been recently reported between the frequent use of early-term preventive labor induction and improvements in multiple parameters of birth health. We sought to replicate these findings in an Italian hospital. The outcomes of 120 consecutively delivered women who were exposed to the alternative method of care were compared to the outcomes of 159 women who received standard management. The primary and secondary outcomes were group cesarean delivery rate and group adverse outcome index score. Exposed women had a higher induction rate, a lower cesarean delivery rate (1.7% vs. 43.4%), and a lower group AOI Score (0.2 vs.5.8). Exposure to high levels of early term preventive labor induction was associated with a lower group cesarean delivery rate and improvement in several other major birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.

The Association Between the Regular Use of Preventive Labor Induction and Improved Term Birth Outcomes

The Association Between the Regular Use of Preventive Labor Induction and Improved Term Birth Outcomes

124: Early-term preventive labor induction in gravidas at increased risk for cesarean delivery–an association between 38-week preventive labor induction and improved birth outcomes

124: Early-term preventive labor induction in gravidas at increased risk for cesarean delivery–an association between 38-week preventive labor induction and improved birth outcomes

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

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

326: Lack of association between early term preventive labor induction and higher neonatal intensive care unit admission rates

326: Lack of association between early term preventive labor induction and higher neonatal intensive care unit admission rates

The Association between Increased Use of Labor Induction and Reduced Rate of Cesarean Delivery

An association was recently reported between a low cesarean section delivery rate and a method of obstetrical care that involved the frequent use of risk-guided prostaglandin-assisted preventive labor induction. We sought to confirm this finding in a subsequent group of pregnant women. A retrospective cohort study design was used to compare the outcomes of 100 consecutively delivered women, who were exposed to the alternative method of care, with the outcomes of 300 randomly chosen women who received standard management. The primary outcome was group cesarean delivery rate. Secondary outcomes were rates of neonatal intensive care unit admission, low 1-minute Apgar score, low 5-minute Apgar score, and major perineal trauma. Women exposed to the alternative method of obstetrical care had a higher induction rate (59% vs. 16.3%, p < 0.001), a more frequent use of prostaglandins for cervical ripening (32% vs. 13%, p < 0.001), and a lower cesarean delivery rate (7% vs. 20.3%, p = 0.002). Exposed women did not experience higher rates of other adverse birth outcomes. Exposure to an alternative method of obstetrical care that used high levels of risk-driven prostaglandin-assisted labor was again associated with two findings: a lower group cesarean delivery rate and no increases in levels of other adverse birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.

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

To determine whether exposure of multiparous women to a high rate of preventive labor induction was associated with a significantly lower cesarean delivery rate. Retrospective cohort study involving 123 multiparous women, who were exposed to the frequent use of preventive labor induction, and 304 multiparous women, who received standard management. Rates of cesarean delivery and other adverse birth outcomes were compared in the 2 groups. Logistic regression controlled for confounding covariates. The exposed group had a lower cesarean delivery rate (adjusted odds ratio, 0.09; 0.8% vs 9.9%; P = .02) and a higher uncomplicated vaginal delivery rate (odds ratio, 0.53; 78.9% vs 66.4%; P = .01). Exposure was not associated with higher rates of other adverse birth outcomes. Exposure of multiparous women 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.

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

The objective of the study was to determine whether exposure of nulliparous women to a high rate of preventive labor induction was associated with improvement in birth health. A risk-scoring system was used to guide the frequent use of preventive labor induction in 100 nulliparous women. The birth outcomes of this group were compared with those of 352 nulliparous women who received usual care. Cesarean delivery was the primary study outcome. The Adverse Outcome Index and the rate of uncomplicated vaginal delivery were used to measure overall birth health. The exposed group experienced a higher labor induction rate (48% vs 23.6%; P < .001), a lower cesarean rate (9% vs 25.8%; adjusted odds ratio, 0.36; P = .02), and better composite birth outcomes. Exposure of nulliparous women to a high preventive induction rate was significantly associated with improvement in birth health. Prospective randomized trials are needed to further explore the utility of risk-guided preventive labor induction.

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

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. 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. 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). 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.

84: Prospective randomized trial of the active management of risk in pregnancy at term: Improved birth outcomes from prostaglandin-assisted preventive labor induction

84: Prospective randomized trial of the active management of risk in pregnancy at term: Improved birth outcomes from prostaglandin-assisted preventive labor induction

A preventive approach to obstetric care in a rural hospital: association between higher rates of preventive labor induction and lower rates of cesarean delivery.

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. Between 1993 and 1997, different hospital practitioners used risk-guided 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. The 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 E2 (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 significant 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. 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.

The active management of risk in multiparous women at term: An association between a higher preventive labor induction rate and a lower cesarean delivery rate

The active management of risk in multiparous women at term: An association between a higher preventive labor induction rate and a lower cesarean delivery rate

The active management of risk in nulliparous patients at term: An association between a higher preventive labor induction rate and a lower cesarean delivery rate

Objective: National primary cesarean delivery rates continue to increase. A recent study reported the association, in a population of mixed parity, between a new method of care and a very low cesarean delivery rate. We wished to re-examine this association in a study involving only nulliparous patients.