Preventive Induced Labor Slows Caesarean Section Rate

July 31, 2007

PHILADELPHIA -- The rising rate of Caesarean deliveries might be slowed by preventive labor induction, researchers here said.

PHILADELPHIA, July 31 -- The rising rate of Caesarean deliveries might be slowed by preventive labor induction, researchers here said.

In a retrospective cohort study, prostaglandin-assisted preventive labor induction reduced C-section rates, without an increase in other adverse outcomes, according to James Nicholson, M.D., of the University of Pennsylvania Health System, and colleagues.

The findings of the four-year investigation suggest that the method -- dubbed Active Management of Risk in Pregnancy at Term, or AMOR-IPAT -- warrants prospective randomized clinical study, Dr. Nicholson and colleagues reported in the July/August issue of Annals of Family Medicine.

The researchers said the current study arose from the observation that rates of Caesarean section in a single rural New England hospital varied inversely with rates of induced labor.

That observation led to the hypothesis that preventive labor induction, used in response to an individual woman's risk profile and aided as necessary by prostaglandin E2 cervical ripening, "might represent a strategy for the safe reduction of Caesarean delivery use," the researchers said.

They noted that the national rate of C-section has been rising for several years and in 2005 hit an all-time high of 30.2% of all births in the U.S.

To test their hypothesis, Dr. Nicholson and colleagues looked at the records of 1,869 women who gave birth at the hospital between October 1, 1993 and September 30, 1997.

The women were divided into an "exposed" group whose doctors used preventive labor induction more than 15% of the time and a "non-exposed" group whose doctors rarely used the practice.

Over the four years, five doctors were identified as high users of preventive labor induction and they gave pre-natal care to 794 women. Eleven doctors rarely used the approach and treated 1,075 women.

Analysis of the records showed that, compared with the nonexposed group, the exposed group:

  • Had a labor induction rate of 31.4% versus 20.4%, a difference that was significant at P