title: The active management of risk in multiparous pregnancy at term: association between a higher preventive labor induction rate and improved birth outcomes.
abstract: OBJECTIVE
  To determine whether exposure of multiparous women to a high rate of preventive labor induction was associated with a significantly lower cesarean delivery rate.
  
  
  METHODS
  Retrospective cohort study involving 123 multiparous women, who were exposed to the frequent use of preventive labor induction, and 304 multiparous women, who received standard management. Rates of cesarean delivery and other adverse birth outcomes were compared in the 2 groups. Logistic regression controlled for confounding covariates.
  
  
  RESULTS
  The exposed group had a lower cesarean delivery rate (adjusted odds ratio, 0.09; 0.8% vs 9.9%; P = .02) and a higher uncomplicated vaginal delivery rate (odds ratio, 0.53; 78.9% vs 66.4%; P = .01). Exposure was not associated with higher rates of other adverse birth outcomes.
  
  
  CONCLUSIONS
  Exposure of multiparous women to a high rate of preventive labor induction was significantly associated with improved birth outcomes, including a very low cesarean delivery rate. A prospective randomized trial is needed to determine causality.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Nicholson
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Morghan H
authors.initials: MH
authors.lastname: Stenson
authors.forename: Peter
authors.initials: P
authors.lastname: Cronholm
authors.forename: Lisa
authors.initials: L
authors.lastname: Kellar
authors.forename: Ian
authors.initials: I
authors.lastname: Bennett
authors.forename: Katie
authors.initials: K
authors.lastname: Margo
authors.forename: Joseph
authors.initials: J
authors.lastname: Stratton
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors