 |
|
Penn study shows lower Cesarean rates associated with preventive labor induction
July 31, 2007Finding challenges conventional belief that inducing labor leads to increases C-sections
PHILADELPHIA -- At a time when national rates of cesarean delivery have climbed above 30%, a four-year study of patients receiving an alternative method of obstetric care experienced a significantly lower rate of cesarean births, according to a study published in the current issue of the Annals of Family Medicine. The study, conducted by researchers at the University of Pennsylvania School of Medicine, reports that a cohort of women exposed to a safe, alternative method of maternity care had a 5.3 percent cesarean delivery rate compared to a 11.8 percent of women who received more traditional care.
The new approach uses a method of pregnancy dating and risk scoring to estimate an optimal time of delivery for each pregnancy. If spontaneous labor has not occurred by this time, preventive labor induction is performed, increasing the likelihood that labor occurs before the fetus has grown too large for the maternal pelvis or before the placenta has grown too old to support the fetus during labor.
The new approach is called the Active Management of Risk in Pregnancy at Term (AMOR-IPAT). AMOR-IPAT evaluates the risk profile for each pregnancy, and uses each risk profile to estimate an optimal time of delivery. Preventive labor induction is used if a woman does not develop spontaneous labor by the upper limit of her optimal time of delivery. Within the term period, the greater the number an severity of risk factors, the earlier preventive labor induction is offered.
The findings support a preventive approach to reduce cesarean deliveries, and challenge the current belief that the use of labor induction leads to higher cesarean delivery risk. The study was conducted at a rural New England hospital and involved 1,869 women. The results of this study are similar to a 400-patient study from an urban setting, published two years ago, that reported a 4 percent cesarean delivery rate in women exposed to AMOR-IPAT.
"The estimation of an optimal time of delivery, using a combination of accurate pregnancy dating and risk-factor scoring, is a concept that suggests a potentially powerful preventive approach to obstetric care,"ť says lead researcher, James M. Nicholson, MD, Assistant Professor of Family Medicine and Community Health at Penn. "By using preventive labor induction to ensure that every women enters labor during her optimal time for vaginal delivery, the AMOR-IPAT approach provides significant health benefits for mothers and babies. "ť Dr. Nicholson also reports that the use of prostaglandin E2 gel for pre-induction cervical ripening, specifically for women scheduled for preventive labor induction who had an unripe cervix, was a key element of in the successful application of AMOR-IPAT.
Vaginal births carry with them a lower rate of morbidity than cesarean births, including decreased chances for post-partum infection and less blood loss. In addition, lower rates of C-section also correspond to lower usage rates in neo-natal intensive care units, shorter lengths of hospital stay for mother and baby, and fewer complications in subsequent pregnancies.
University of Pennsylvania School of Medicine
The new approach is called the Active Management of Risk in Pregnancy at Term (AMOR-IPAT). AMOR-IPAT evaluates the risk profile for each pregnancy, and uses each risk profile to estimate an optimal time of delivery. Preventive labor induction is used if a woman does not develop spontaneous labor by the upper limit of her optimal time of delivery. Within the term period, the greater the number an severity of risk factors, the earlier preventive labor induction is offered.
The findings support a preventive approach to reduce cesarean deliveries, and challenge the current belief that the use of labor induction leads to higher cesarean delivery risk. The study was conducted at a rural New England hospital and involved 1,869 women. The results of this study are similar to a 400-patient study from an urban setting, published two years ago, that reported a 4 percent cesarean delivery rate in women exposed to AMOR-IPAT.
"The estimation of an optimal time of delivery, using a combination of accurate pregnancy dating and risk-factor scoring, is a concept that suggests a potentially powerful preventive approach to obstetric care,"ť says lead researcher, James M. Nicholson, MD, Assistant Professor of Family Medicine and Community Health at Penn. "By using preventive labor induction to ensure that every women enters labor during her optimal time for vaginal delivery, the AMOR-IPAT approach provides significant health benefits for mothers and babies. "ť Dr. Nicholson also reports that the use of prostaglandin E2 gel for pre-induction cervical ripening, specifically for women scheduled for preventive labor induction who had an unripe cervix, was a key element of in the successful application of AMOR-IPAT.
Vaginal births carry with them a lower rate of morbidity than cesarean births, including decreased chances for post-partum infection and less blood loss. In addition, lower rates of C-section also correspond to lower usage rates in neo-natal intensive care units, shorter lengths of hospital stay for mother and baby, and fewer complications in subsequent pregnancies.
University of Pennsylvania School of Medicine
Cesarean Current Events and Cesarean News RSSPatience during stalled labor can avoid many c-sections, UCSF study shows
Pregnant women whose labor stalls while in the active phase of childbirth can reduce health risks to themselves and their infants by waiting out the delivery process for an extra two hours, according to a new study by researchers at the University of California, San Francisco.
Post-term pregnancies risk infant's life and health, UCSF studies show
Infants born more than one week past their due dates have a higher risk of both impaired health and death, according to two new studies by authors from the University of California's San Francisco and Berkeley campuses.
Research in AJN shows increase in private and public place infant abductions
The American Journal of Nursing (AJN) announced today results from a study, based on 23 years of data collection, identifying new trends in nonfamily infant abductions.
Maternal deaths following cesarean delivery can be reduced
Maternal death rates have remained constant in the United States for many decades. Are there any improvements in health care that could reduce these rates further?
Preterm birth contributes to growing number of infant deaths
Babies born too soon and too small accounted for a growing proportion of infant deaths, according to new statistics released today from the National Center for Health Statistics, (NCHS).
Caesarean sections associated with risk of asthma
Babies born by Caesarean section have a 50 % increased risk of developing asthma compared to babies born naturally. Emergency Caesarean sections increase the risk even further.
New method of managing risk in pregnancy leads to healthier newborns, better outcomes for moms
An alternative method for obstetric care has led to lower neonatal intensive care unit (NICU) admission rates, higher uncomplicated vaginal birth (UVB) rates, and a lower mean Adverse Outcome Index (AOI) score.
C-sections a critical factor in preterm birth increase
Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data.
Possible biological explanation for C-Section-linked allergies and asthma found
Scientists believe they may have identified a biological explanation for the link between cesarean-section delivery and risk of allergy and asthma in childhood.
Too much or too little weight gain poses risks to pregnant mothers, babies
Women who gain more or less than recommended amounts of weight during pregnancy are likely to increase the risk of problems for both themselves and their child, according to a new report by the RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center.
More Cesarean Current Events and Cesarean News Articles
 | Birth After Cesarean: The Medical Facts by Bruce L. Flamm A patient advocacy book, filled with recommendations and support for women who want to deliver normally even when they've had a prior cesarean. In a straightforward question-and-answer format, Dr. Bruce Flamm assesses the conflicting information many pregnant women... |
 | The Essential C-Section Guide: Pain Control, Healing at Home, Getting Your Body Back, and Everything Else You Need to Know About a Cesarean Birth by Maureen Connolly, Dana Sullivan Childbirth is a life-altering experience for any woman, but a Cesarean delivery can be overwhelming, whether it’s unexpected or planned. Despite the fact that roughly one in four babies in the United States is delivered by c-section, very little information about the experience is included in typical pregnancy books and physicians and childbirth educators often gloss over the details.The... |
| Natural Childbirth After Cesarean: A Practical Guide by Karis Crawford, Johanne C. Walters This work addresses the issues which face physicians and families when looking at the statistics and alternatives of a caesarean birth. Both the authors have given birth naturally after having had two caesareans each. In a decade of counselling and coaching hundreds of other women through the process, they have gathered a store of knowledge that they share through many lively family vignettes.... | |
 | Cesarean Recovery by Chrissie Gallagher-Mundy The complete guide to a healthy recovery from the effects of C-section birthing. Almost 1 out of 4 deliveries is by cesarean section. Whether or not the procedure is planned, cesarean section must be considered major abdominal surgery and surgical recovery is a necessary process towards complete healing. Cesarean Recovery guides new mothers through the healing process in conjunction with... |
 | Understanding the Dangers of Cesarean Birth: Making Informed Decisions (The Praeger Series on Contemporary Health and Living) by Nicette Jukelevics Cesarean delivery - childbirth through an incision in the mother's lower abdomen - is now the most common major surgical procedure performed in the United States. No one argues over the fact that it can be a life-saving procedure when the baby or mother is at risk. But for almost three decades in this nation, cesarean deliveries have increased, without substantially better outcomes for babies or... |
| Cesarean Voices 68... | |
| The Vaginal Birth After Cesarean (VBAC) Experience: Birth Stories by Parents and Professionals by Lynn Baptisti Richards Here for the first time are intimate stories of the VBAC (vaginal birth after cesarean) experience, as told by mothers, fathers, midwives, obstetricians, labor coaches, and others whose lives have been affected by VBAC. The stories demystify in a powerful way the idea of "once a cesarean, always a cesarean." By example, each story is a telling critique of birthing practices in general and the... | |
 | Trust Your Body! Trust Your Baby!: Childbirth Wisdom and Cesarean Prevention Includes chapter by Dr. John Gray, author of the best-selling, Men are from Mars, Women are from Venus! Over one million cesarean sections are performed each year in America. Only one-half of these invasive procedures are medically necessary. In the name of technological progress, hundreds of thousands of women have been coerced into relinquishing a most cherished right--the right to give birth... |
 | Cesarean Section: Understanding and Celebrating Your Baby's Birth (A Johns Hopkins Press Health Book) by Michele C. Moore, Caroline M. de Costa One in four babies born in the United States and Europe comes into the world via Cesarean section. Yet this procedure has been described by critics as an unnecessary and potentially dangerous medical intervention. Consequently, expectant mothers often fear this option, and women who have had C-sections can feel a sense of failure.In Cesarean Section: Understanding and Celebrating Your Baby's... |
 | Cesarean Delivery: Its Impact on the Mother and Newborn - Part I, An Issue of Clinics in Perinatology (The Clinics: Internal Medicine) by Lucky Jain, Ronald Wapner This two-part issue of Clinics in Perinatology examines Cesarean Delivery, with an emphasis on topics of special interest to neonatal and maternal fetal medicine specialists. Guest Editors Lucky Jain and Ronald Wapner have assembled a panel of world-class experts who offer reviews on topics including Cesarean Birth in the US: Epidemiology and Trends; The Ethical Debate of Maternal Choice and... |
| © 2008 BrightSurf.com |