title: Active management of risk in pregnancy at term in an urban population: an association between a higher induction of labor rate and a lower cesarean delivery rate.
abstract: OBJECTIVE
  The purpose of this study was to determine whether exposure to an alternative method of care, called the active management of risk in pregnancy at term, was associated with a lower group cesarean delivery rate.
  
  
  METHODS
  Active management of risk in pregnancy at term used risk factors for cesarean delivery to guide an increased use of labor induction. A retrospective cohort design was used to compare clinical outcomes of 100 pregnant women who were exposed to active management of risk in pregnancy at term to 300 randomly selected subjects who received standard management.
  
  
  RESULTS
  The 2 groups had comparable levels of prenatal risk. The group exposed to the active management of risk in pregnancy at term exposure group encountered a higher induction rate (63% vs 25.7%; P < .001) and a lower cesarean delivery rate (4% vs 16.7%; P = .01). Findings were similar for both nulliparous and multiparous subgroups. Active management of risk in pregnancy at term exposure was not associated with higher rates of other major birth outcomes.
  
  
  CONCLUSIONS
  Exposure to the active management of risk in pregnancy at term exposure was associated with a significantly lower group cesarean delivery rate. A prospective randomized trial that involved active management of risk in pregnancy at term exposure is needed to further explore this association.
authors.affiliation: Department of Family Practice and Community Medicine,University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Kellar
authors.forename: Peter F
authors.initials: PF
authors.lastname: Cronholm
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008499:Medical Records; D010298:Parity; D015143:Philadelphia / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D012307:Risk Factors; D014504:Urban Health