title: The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Samuel
authors.initials: S
authors.lastname: Parry
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Sarah
authors.initials: S
authors.lastname: Rosen
authors.forename: Allison
authors.initials: A
authors.lastname: Keen
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016016:Proportional Hazards Models; D014505:Urban Population / Q000706:statistics & numerical data