The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial

James M. Nicholson, Samuel Parry, Aaron Caughey, Sarah Rosen, Allison Keen, George A. Macones

Research output: Contribution to journalArticle

51 Scopus citations


Objective: The purpose of this study was to compare birth outcomes that result from the active management of risk in pregnancy at term (AMOR-IPAT) to those outcomes that result from standard management. Study Design: This was a randomized clinical trial with 270 women of mixed parity. AMOR-IPAT used preventive labor induction to ensure delivery before the end of an estimated optimal time of delivery. Rates of 4 adverse obstetric events and 2 composite measures were used to evaluate birth outcomes. Results: The AMOR-IPAT-exposed group had a similar cesarean delivery rate (10.3% vs 14.9%; P = .25), but a lower neonatal intensive care unit admission rate (1.5% vs 6.7%; P = .03), a higher uncomplicated vaginal birth rate (73.5% vs 62.8%; P = .046), and a lower mean Adverse Outcome Index score (1.4 vs 8.6; P = .03). Conclusion: AMOR-IPAT exposure improved the pattern of birth outcomes. Larger randomized clinical trials are needed to explore further the impact of AMOR-IPAT on birth outcomes and to determine the best methods of preventive labor induction.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Issue number5
Publication statusPublished - May 2008
Externally publishedYes



  • adverse outcome index
  • cesarean delivery
  • neonatal intensive care unit admission
  • preventive labor induction
  • uncomplicated vaginal delivery

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

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