| > |
A 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 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 and severity of risk factors,
the earlier preventive labor induction is offered. |
| > |
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 study
was published in the current issue of the Annals of Family
Medicine. |
(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
and 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,” 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.” 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.
The pilot study for this project was funded by Forest
Pharmaceuticals, Inc., in 2000. In addition, Forest Pharmaceuticals has provided,
at no cost, its dinoprostone
vaginal insert cervical ripening product for use in an ongoing randomized clinical trial of AMOR-IPAT. This
prospective study, which is supported by the NICHD/NIH and the
Pennsylvania Hospital Foundation, is being performed within the
University of Pennsylvania
Health System.
###
PENN Medicine is
a $3.5 billion enterprise dedicated to the related missions
of medical education, biomedical research, and excellence in
patient care. PENN Medicine consists of the University of Pennsylvania
School of Medicine (founded in 1765 as the nation's first medical
school) and the University of Pennsylvania Health System.
Penn's School of Medicine is currently ranked #3 in
the nation in U.S.News & World Report's survey of top research-oriented
medical schools; and, according to most recent data from the
National Institutes of Health, received over $379 million in
NIH research funds in the 2006 fiscal year. Supporting 1,400
fulltime faculty and 700 students, the School of Medicine is
recognized worldwide for its superior education and training
of the next generation of physician-scientists and leaders
of academic medicine.
The University of Pennsylvania Health System includes
three hospitals — its flagship hospital, the
Hospital of the University of Pennsylvania, rated one of the
nation’s “Honor Roll” hospitals by U.S.News & World
Report; Pennsylvania Hospital, the nation's first hospital; and
Penn Presbyterian Medical Center — a faculty practice
plan; a primary-care provider network; two multispecialty satellite
facilities; and home care and hospice.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.