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Active management of risk in pregnancy at term did not reduce caesarean delivery rates

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J M Nicholson

Dr J M Nicholson, University of Pennsylvania, Philadelphia, PA, USA; james.nicholsonmd@uphs.upenn.edu

STUDY DESIGN

Design:

randomised controlled trial (RCT).

Allocation:

concealed.*

Blinding:

unblinded.*

STUDY QUESTION

Setting:

3 centres in Philadelphia, Pennsylvania, USA.

Patients:

281 pregnant women (mean age 23 y, 88% African-American) who remained undelivered at 37 weeks 4 days of gestation and had ⩾1 of 6 risk factors for caesarean delivery: age ⩾35 years, height ⩽157 cm, body mass index ⩾30 kg/m2, blood pressure elevation or anaemia in the first trimester, or history of a large fetus. Exclusion criteria included multiple gestation, previous caesarean delivery, placenta previa, HIV infection, and contraindication to labour.

Intervention:

women were managed in late pregnancy according to the active management of risk in pregnancy at term (AMOR-IPAT) method (n = 136) or usual care (n = 134). AMOR-IPAT involves 3 steps: (1) a risk scoring system to …

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