American Journal of Obstetrics & Gynecology
Volume 198, Issue 5 , Pages 511.e1-511.e15 , May 2008

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

Presented at the 28th Annual Meeting of the Society for Maternal-Fetal Medicine, Dallas, TX, Jan. 28-Feb. 2, 2008.

  • James M. Nicholson, MD, MSCE

      Affiliations

    • Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
    • ,
  • Samuel Parry, MD

      Affiliations

    • Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
    • ,
  • Aaron B. Caughey, MD PhD

      Affiliations

    • Department of Obstetrics and Gynecology, University of California, San Francisco, CA
    • ,
  • Sarah Rosen, MD

      Affiliations

    • Pennsylvania Hospital, Philadelphia, PA
    • ,
  • Allison Keen, MD

      Affiliations

    • Pennsylvania Hospital, Philadelphia, PA
    • ,
  • George A. Macones, MD, MSCE

      Affiliations

    • Department of Obstetrics and Gynecology, Washington University, St. Louis, MO.

References 

  1. Martin JA, Brady EH, Paul PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2002. Natl Vital Stat Rep. 2003;52:1–117
  2. Martin JA, Hamilton BE, Menacker F, Sutton PD, Mathews TJ. Preliminary births for 2004: infant and maternal health: health e-stats. Hyattsville (MD): National Center for Health Statistics; 2005;
  3. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2006. Natl Vital Stat Rep. 2007;56:1–18
  4. Linne Y. Effects of obesity on women's reproduction and complication during pregnancy. Obes Rev. 2004;5:137–143
  5. Ecker JL, Frigoletto FD. Cesarean delivery and the risk-benefit calculus. N Engl J Med. 2007;356:885–888
  6. Boulet SL, Alexander GR, Salihu HM. Secular trends in cesarean delivery rates among macrosomic deliveries in the United States, 1989 to 2002. J Perinatol. 2005;25:569–576
  7. Localio AR, Lawthers AG, Bengston JM, et al. Relationship between malpractice claims and cesarean delivery. N Engl J Med. 1993;269:366–373
  8. Murthy K, Grobman WA, Lee TA, Holl JL. Association between rising professional liability insurance premiums and primary cesarean delivery rates. Obstet Gynecol. 2007;110:1264–1269
  9. Lal M. Prevention of urinary and anal incontinence: role of elective cesarean delivery. Curr Opin Obstet Gynecol. 2003;15:439–448
  10. Minkoff H, Chervenak FA. Elective primary cesarean delivery. N Engl J Med. 2003;348:946s–950s
  11. Singh GK, Yu SM. Infant mortality in the United States: trends, differentials, and projections, 1950-2010. Am J Public Health. 1995;85:957–964
  12. Kung HC, Hoyert DL, Xu J, Murphy SL. Deaths: preliminary data for 2005: health e-stats. Hyattsville (MD): National Center for Health Statistics; 2007;
  13. Nicholson JA, Kellar LC, Cronholm PF, Macones GA. Active management of risk in pregnancy at term: an association between a higher induction of labor rate and a lower cesarean delivery rate. Am J Obstet Gynecol. 2004;191:1516–1528
  14. Nicholson JM, Yeager DL, Macones GA. A preventive approach to obstetric care in a rural hospital: association between higher rates of preventive labor induction and lower rates of cesarean delivery. Ann Fam Med. 2007;5:310–319
  15. Nicholson JM, Kellar LC, Cronholm PF, Macones GA. Active management of risk in pregnancy at term in an urban population: an association between higher induction of labor rates and lower cesarean delivery rates [abstract]. Am J Obstet Gynecol. 2003;189(suppl):S131
  16. Nicholson JM, Holt M, Caughey AB, Macones GA. 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 [abstract]. Am J Obstet Gynecol. 2005;193(suppl):S117
  17. Nicholson JM, Caughey AB, Stenson M, Kellar LC, Cronholm PF. The active management of risk in multiparous patients at term: an association between a higher preventive induction of labor rate and a lower cesarean delivery rate [abstract]. Am J Obstet Gynecol. 2006;195(suppl):S99
  18. Socol M. Elective induction of labor: should we make a fuss?. Am J Obstet Gynecol. 2004;191:1509–1510
  19. Klein MC. Association not causation: what is the intervention?. Ann Fam Med. 2007;5:294–297
  20. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol. 2006;108:541–548
  21. Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. Can Med Assoc J. 2007;176:455–460
  22. Hager RM, Daltveit AK, Hofoss D, et al. Complications of cesarean deliveries: rates and risk factors. Am J Obstet Gynecol. 2004;190:428–434
  23. Thompson JF, Roberts CL, Currie M, Ellwood DA. Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth. 2002;29:83–94
  24. Villar J, Carroli G, Zavaleta N, et al. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicenter prospective study. BMJ. 2007;335:1025–1029
  25. MacDorman MF, Declercq E, Menacker F, Malloy MH. Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk”, United States, 1998-2001 birth cohorts. Birth. 2006;33:175–182
  26. Kennare R, Tucker G, Heard A, Chan A. Risks of adverse outcomes in the next birth after a first cesarean delivery. Obstet Gynecol. 2007;109:270–276
  27. Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003;362:1779–1784
  28. Minkoff H, Chervenak FA. Elective primary cesarean delivery. N Engl J Med. 2003;348:946–950
  29. Rogers R. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029–1036
  30. Lukacz E, Lawrence J, Contreras R, Nager CW, Luber K. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006;107:1253–1260
  31. Hannah ME, Whyte H, Hannah WJ, et al. Maternal outcomes at 2 years after planned cesarean delivery versus planned vaginal birth for breech presentation at term: the international randomized term breech trial. Am J Obstet Gynecol. 2004;191:917–927
  32. Dietz HP. Pelvic floor trauma following vaginal delivery. Curr Opin Obstet Gynecol. 2006;18:528–537
  33. Nicholson JM, Holt M. Will active management of obstetric risk lower C/S rates?. Contemp Obstet Gynecol. 2005;50:38–53
  34. Nicholson JM, Kellar LC, Kellar GM. The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery. J Perinatol. 2006;26:392–402
  35. Bujold E, Blackwell SC, Hendler I, Berman S, Sorokin K, Gauthier RJ. Modified Bishop's score and induction of labor in patients with a previous cesarean delivery. Am J Obstet Gynecol. 2004;191:1644–1648
  36. Nielsen PE, Goldman MB, Mann S, et al. Effects of teamwork training on adverse outcomes and process of care in labor and delivery. Obstet Gynecol. 2007;109:48–55
  37. Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol. 2006;195:700–705
  38. Caughey AB, Musci TJ. Complications of term pregnancies beyond 37 weeks of gestation. Obstet Gynecol. 2004;103:57–62
  39. Caughey AB, Washington AE, Laros RK. Neonatal complications of term pregnancy: Rates by gestational age increase in a continuous, not threshold, fashion. Am J Obstet Gynecol. 2005;192:185–190
  40. Caughey AB, Stotland NE, Washington AE, Escobar GJ. Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term. Am J Obstet Gynecol. 2007;196:155–156
  41. Heimstad R, Romundstad PR, Eik-Nes SH, Salvesen KA. Outcomes of pregnancy beyond 37 weeks of gestation. Obstet Gynecol. 2006;108:500–508
  42. Sanchez-Ramos L, Olivier F, Delke I, Kaunitz AM. Labor induction versus expectant management for postterm pregnancies: a systematic review with meta-analysis. Obstet Gynecol. 2003;101:1312–1318
  43. Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term. Cochrane Database Syst Rev. 2007;(3):CD000170
  44. Main EK, Bloomfield L, Hunt G. Development of a large-scale obstetric quality-improvement program that focused on the nulliparous patient at term. Am J Obstet Gynecol. 2004;190:1747–1758
  45. Cammu H, Martens G, Ruyssinck G, Amy JJ. Outcome after elective induction in nulliparous women: a matched cohort study. Am J Obstet Gynecol. 2002;186:240–244
  46. Yeast JD, Jones A, Poskin M. Induction of labor and the relationship to cesarean delivery: a review of 7001 consecutive inductions. Am J Obstet Gynecol. 1999;180:628–633
  47. Coonrod DV, Bay RC, Kishi GY. The epidemiology of labor induction: Arizona 1997. Am J Obstet Gynecol. 2000;182:1355–1362
  48. Seyb ST, Berka RJ, Socol ML, Dooley SL. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol. 1999;94:600–607
  49. Ben-Haroush A, Yogev Y, Bar J, Glickman H, Kaplan B, Hod M. Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section. J Perinatal Med. 2004;32:31–36
  50. Alexander JM, MCIntire DD, Leveno KJ. Prolonged pregnancy: induction of labor and cesarean births. Obstet Gynecol. 2001;97:911–915
  51. Caughey AB. What is the optimal gestational age for delivery?. J Perinatol. 2006;26:387–388
  52. Ek S, Andersson A, Johansson A, Kublicas M. Oligohydramnios in uncomplicated pregnancies beyond 40 completed weeks: a prospective, randomized, pilot study on maternal and neonatal outcomes. Fetal Diagn Ther. 2005;20:182–185
  53. Gonen O, Rosen DJ, Dolfin Z, Tepper R, Markov S, Fedjin MD. Induction of labor versus expectant management in macrosomia: a randomized study. Obstet Gynecol. 1997;89:913–917
  54. Kjos SL, Henry OA, Montoro M, Buchanan TA, Mestman JH. Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management. Am J Obstet Gynecol. 1993;169:611–615
  55. Martin DH, Thompson W, Pinkerton JHM, Watson JD. A randomized controlled trial of selective planned delivery. BJOG. 1978;85:109–113
  56. Nielsen PE, Howard BC, Hill CC, Larson PL, Holland RH, Smith PN. Comparison of elective induction of labor with favorable Bishop scores versus expectant management: a randomized clinical trial. J Matern Fetal Neonat Med. 2005;18:59–64
  57. Ohel G, Rahav D, Rothbart H, Ruach M. Randomized trial of outpatient induction of labor with vaginal PGE2 at 40-41 weeks of gestation versus expectant management. Arch Gynecol Obstet. 1996;258:109–112
  58. Amano K, Saito K, Shoda T, Tani A, Yoshihara H, Nishijima M. Elective induction of labor at 39 weeks of gestation: a prospective randomized trial. J Obstet Gynaecol Res. 1999;25:33–37
  59. Cole RA, Howie PW, Macnaughton MC. Elective induction of labour: a randomized prospective. Lancet. 1975;1:767–770
  60. Dyson DC, Miller PD, Armstrong MA. Management of prolonged pregnancy: induction of labor versus antepartum fetal testing. Am J Obstet Gynecol. 1987;156:928–934
  61. Hannah ME, Hannah WJ, Hellmann J, et al. Induction o labor as compared with serial antenatal monitoring in post-term pregnancy. N Engl J Med. 1992;326:1587–1592

 Supported by the National Institute of Child Health and Human Development of the National Institutes of Health (K23-HD-42043) and by a research grant from the First Hospital Foundation. Forest Pharmaceuticals provided dinoprostone pledgets for use at the Hospital of the University of Pennsylvania.

 Cite this article as: Nicholson JM, Parry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial. Am J Obstet Gynecol 2008;198:511.e1-511.e15.

 Reprints not available from the authors.

PII: S0002-9378(08)00301-3

doi: 10.1016/j.ajog.2008.03.037

American Journal of Obstetrics & Gynecology
Volume 198, Issue 5 , Pages 511.e1-511.e15 , May 2008

Article Tools

* Image Usage & Resolution