Document Detail


The active management of risk in multiparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes.
MedLine Citation:
PMID:  19254584     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether 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 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.
RESULTS: 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.
CONCLUSION: 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.
Authors:
James M Nicholson; Aaron B Caughey; Morghan H Stenson; Peter Cronholm; Lisa Kellar; Ian Bennett; Katie Margo; Joseph Stratton
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  200     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-03     Completed Date:  2009-04-06     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250.e1-250.e13     Citation Subset:  AIM; IM    
Affiliation:
Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cesarean Section / statistics & numerical data
Female
Humans
Infant, Newborn
Intensive Care, Neonatal / statistics & numerical data
Labor, Induced / statistics & numerical data*
Logistic Models
Parity*
Pregnancy
Pregnancy Complications / epidemiology*,  prevention & control*
Pregnancy Outcome / epidemiology*
Retrospective Studies
Risk Factors
Grant Support
ID/Acronym/Agency:
K23 HD042043-01/HD/NICHD NIH HHS; K23 HD042043-02/HD/NICHD NIH HHS; K23 HD042043-03/HD/NICHD NIH HHS; K23 HD042043-04/HD/NICHD NIH HHS; K23 HD042043-05/HD/NICHD NIH HHS
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