title: The association between increased use of labor induction and reduced rate of cesarean delivery.
abstract: OBJECTIVE
  An association was recently reported between a low cesarean section delivery rate and a method of obstetrical care that involved the frequent use of risk-guided prostaglandin-assisted preventive labor induction. We sought to confirm this finding in a subsequent group of pregnant women.
  
  
  METHODS
  A retrospective cohort study design was used to compare the outcomes of 100 consecutively delivered women, who were exposed to the alternative method of care, with the outcomes of 300 randomly chosen women who received standard management. The primary outcome was group cesarean delivery rate. Secondary outcomes were rates of neonatal intensive care unit admission, low 1-minute Apgar score, low 5-minute Apgar score, and major perineal trauma.
  
  
  RESULTS
  Women exposed to the alternative method of obstetrical care had a higher induction rate (59% vs. 16.3%, p < 0.001), a more frequent use of prostaglandins for cervical ripening (32% vs. 13%, p < 0.001), and a lower cesarean delivery rate (7% vs. 20.3%, p = 0.002). Exposed women did not experience higher rates of other adverse birth outcomes.
  
  
  CONCLUSIONS
  Exposure to an alternative method of obstetrical care that used high levels of risk-driven prostaglandin-assisted labor was again associated with two findings: a lower group cesarean delivery rate and no increases in levels of other adverse birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.
authors: Department of Family Practice and Community Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania19104, USA. james.nicholsonMD@uphs.upenn.edu
authors: James M
authors: JM
authors: Nicholson
authors: Peter
authors: P
authors: Cronholm
authors: Lisa C
authors: LC
authors: Kellar
authors: Morghan H
authors: MH
authors: Stenson
authors: George A
authors: GA
authors: Macones
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015232:Dinoprostone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000379:methods* / Q000706:statistics & numerical data*; D016595:Misoprostol / Q000008:administration & dosage; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000379:methods*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D010120:Oxytocics; D016595:Misoprostol; D015232:Dinoprostone