Active Management of Risk in Nulliparous Pregnancy at Term

In this study, multiparous women were exposed to a high rate of preventive labor induction, which was significantly associated with a very low cesarean delivery rate and fewer complications.

Cesarean delivery is associated with higher rates of excessive blood loss, postpartum infection, and maternal mortality than simple vaginal delivery. Yet the U.S. rates of cesarean delivery have increased over the past decade. One strategy for reducing group cesarean delivery rates involves using cesarean delivery risk factors to guide use of preventive labor induction. This strategy, called active management of risk in pregnancy at term (AMOR-IPAT), uses preventive labor induction to increase the likelihood that labor begins before conditions develop that make vaginal delivery less likely. This retrospective cohort study sought to determine whether exposure of multiparous women to AMOR-IPAT was associated with a significantly lower cesarean delivery rate. The study compared rates of cesarean delivery and other adverse birth outcomes between two groups: 123 multiparous women who were exposed to the preventive labor induction, and 304 multiparous women who received standard management.

Key Findings:

  • The exposed group had a significantly lower cesarean delivery rate; a significantly higher uncomplicated vaginal delivery rate; and significantly lower rates of complications such as major perineal injury and excessive blood loss.
  • Exposure was not associated with higher rates of other adverse birth outcomes.

These findings describe a possible strategy to safely lower cesarean delivery use in multiparous women. A prospective randomized controlled trial could help to determine causality.