title: Active management of risk in nulliparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes.
abstract: OBJECTIVE
  The objective of the study was to determine whether exposure of nulliparous women to a high rate of preventive labor induction was associated with improvement in birth health.
  
  
  METHODS
  A risk-scoring system was used to guide the frequent use of preventive labor induction in 100 nulliparous women. The birth outcomes of this group were compared with those of 352 nulliparous women who received usual care. Cesarean delivery was the primary study outcome. The Adverse Outcome Index and the rate of uncomplicated vaginal delivery were used to measure overall birth health.
  
  
  RESULTS
  The exposed group experienced a higher labor induction rate (48% vs 23.6%; P < .001), a lower cesarean rate (9% vs 25.8%; adjusted odds ratio, 0.36; P = .02), and better composite birth outcomes.
  
  
  CONCLUSIONS
  Exposure of nulliparous women to a high preventive induction rate was significantly associated with improvement in birth health. Prospective randomized trials are needed to further explore the utility of risk-guided preventive labor induction.
authors.affiliation: Department of Family Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: James M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Morghan H
authors.initials: MH
authors.lastname: Stenson
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Kellar
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors