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Dr. James M. Nicholson  Dr. James Nicholson

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% cesarean delivery rate compared to an 11.8% 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 in 2009, which reported a 4% cesarean delivery rate in women exposed to AMOR-IPAT.

Latest News

  • NEW! (2016) Paper addressing the potential impact of the “39-week rule” on the rates of USA term stillbirths. Because of reported associations between early-term delivery and various neonatal morbidities, an obstetric guideline called “the 39-week rule” was formally implemented in 2010 throughout the USA. The rule restricts “non-indicated” planned delivery prior to 39 weeks of gestation. However, several publications have suggested that the rule, by increasing the mean gestational age of term delivery, might increase population rates of term stillbirth. The objective of this large study was to determine if implementation of the 39-week rule was associated with an increase in the USA rate of term stillbirth.
  • NEW! (2016) Letter to the Editor expressing concern about the recent collection of articles published in the December 2015 issue of Obstetrics & Gynecology suggesting that the 39-week rule has not increased the rate of U.S. term stillbirth.
           Publisher's link

  • NEW! Radio Interview. "AMOR-IPAT: A New Idea to Reduce the Rate of Cesarean Section." This is a November 2008 radio interview with Dr. Lisa Mazzullo, host of ReachMD, XM160, Advances in Women's Health, in which Dr. Nicholson talks about the AMOR-IPAT approach to pregnancy care and how it can help reduce the rate of cesarean section.
           Audio  •   Transcript

  • NEW! Award! (2016) It's official! Dr. Nicholson was awarded the Star Legacy Foundation's first ever Star Legacy Stillbirth Awareness Star Award at the Foundation's 1st annual Gala held on February 13, 2016 in Eden Prairie, MN. As noted on the Foundation's website, "The recipient of this award is someone who has been effective in bringing stillbirth out of the shadows. They have shown the ability to connect with our society to bring attention to the needs of the stillbirth community."
  • NEW! (2015) Stillbirth Summit 2014 meeting paper addressing the potential impact of the “39-week rule” on the rates of USA term stillbirths. Argues that the 39-week rule is not supported by high-quality evidence, its strict application unjustifiably obstructs patient autonomy, and it may actually cause harm in the form of early-term stillbirth. Because of these problems the 39-week rule should be modified, made optional, or withdrawn. Patients should be able to request and receive early-term labor induction if they believe that such an intervention is in the best interest of themselves and/or their fetus.
  • NEW! CAOI Score Survey
    We are developing a method of evaluating childbirth outcomes called the "Childbirth Adverse Outcome Index Score" (CAOI Score). The CAOI Score will be based on a list of the potential major adverse outcomes that can occur during pregnancy, labor and childbirth, and will assign a numerical value to each outcome. To help facilitate development of this new Score, we are soliciting input from as many interested stakeholders as possible, including pregnant women and/or their partners or other family members, health care providers (doctors, nurses, mid-wives, etc.), insurance providers, hospital administrators, etc. To this end, we encourage you to help us in this research effort by completing this brief, anonymous, online survey.
  • NEW! Visit the improved and expanded AMOR-IPAT Bibliography. Key new features include article abstracts, free-text searching of all fields and/or progressive filtering by author, year, journal title and keyword.
  • NEW! The AMOR-IPAT Discussion Forum is now live! This is a great place to discuss and keep informed about current news, research and ideas related to preventive induction issues, and to share experiences and voice opinions.
  • (2015) A meta-analysis of four studies compared term birth outcomes following either the current standard approach with its emphasis on the expectant management of intermediate-level risk or the regular use of preventive induction. The purpose was to assess published associations between the regular use of modelled risk-based 'non-indicated' term labour induction and rates of common adverse birth outcomes. The conclusion was that the regular use of preventive induction, as compared with the current standard approach, is associated with a more favourable pattern of birth outcomes.
  • (2014) A large, comprehensive, meta-analysis, just published in the Canadian Medical Association Journal, involving 157 randomized controlled trials, provides the most compelling evidence yet that induction of labor actually lowers the risk of cesarean delivery. Moreoever, the study found that induction has other fetal and birth outcome benefits.
  • (2013) Letter to the Editor questioning the efficacy of a recent proposal to subcategorize term pregnancy into three distinct categories based only on gestational age. The letter argues that doing so would provide an oversimplified construct for stratifying term pregnancy, and further warns that there is a chance that the proposed stratification, especially if combined with untested applications, may cause more harm than good.
  • (2014) Paper suggesting that waiting for delivery until 39 weeks' gestation in both high and low risk pregnancies, as compared to delivery in the 37th or 38th week of gestation, would result in an increased number of perinatal deaths (term fetal deaths [stillbirths] plus neonatal deaths). The paper concludes that decisions regarding the "optimal time for delivery" should include the risk of remaining undelivered.
  • (2011) Paper indicating that a policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, macrosomia and stillbirth increased.
  • (2009) Large review by USA physicians, funded by AHRQ, supports the concept that non-indicated (elective) term labor induction, when compared to expectant management to a later gestational age, might provide more benefit than harm.
  • (2012) Large review by Scottish physicians also suggested that non-indicated labor induction might be more beneficial than harmful.
  • (2012) Paper suggesting that the use of non-indicated labor induction for impending macrosomia might lower risk of cesarean delivery.
  • (2012) Paper suggesting that the use of non-indicated labor induction might lower the risk of term stillbirth.

New Research

Several new research projects are in the planning stage, including:

  • A cost-effectiveness study of the HUP-POP Trial.
  • A study of the relationship between yearly labor induction rates and yearly adverse birth outcomes rates.
  • Possible submission to the NICHD of the NIH for funding for a multi-site R01 RCT proposal involving the use of AMOR-IPAT.

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