Active management approach improves birth outcomes

NEW YORK (Reuters Health) - A new approach for managing risk in pregnancy can improve outcome for mom and baby, research suggests.

The approach, known as Active Management of Risk in Pregnancy at Term -- or AMOR-IPAT -- evaluates the risk profile for each pregnancy, and uses the risk profile to estimate the best time for a woman to deliver her baby. If a woman does not go into labor spontaneously by the end of her optimal time of delivery, labor is induced. A major goal of the program is to reduce the rate of cesarean sections and improve birth outcomes.

In the current study, Dr. James M. Nicholson, of the University of Pennsylvania, in Philadelphia, randomly assigned 270 women to receive AMOR-IPAT care or standard obstetrics care.

The investigators report that the c-section rate in the AMOR-IPAT group was 10 percent -- lower but not significantly different from the 15 percent rate seen in standard care group.

Newborns in the AMOR-IPAT group, however, were less apt to require admission to the neonatal intensive care unit and had lower average "Adverse Outcome Index" scores, compared with newborns in the standard care group.

Moreover, women in the AMOR-IPAT group were more likely to have an uncomplicated vaginal birth than women in the standard group (74 percent versus 63 percent).

These findings, the investigators say, challenge the notion that inducing labor leads to higher c-section rates.

"By using preventive labor induction to ensure that every woman enters labor during her optimal time for vaginal delivery, the AMOR-IPAT approach provides significant health benefits for mothers and babies," Nicholson said in a university-issued statement. Further studies on AMOR-IPAT are warranted, the researchers conclude.

SOURCE: American Journal of Obstetrics & Gynecology May, 2008.