{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:47:07Z","timestamp":1790804827174,"version":"4.1.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>\n            Objectives\u2003The aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction.<\/jats:p><jats:p>\n            Study Design\u2003This was a retrospective cohort study of singleton pregnancies at \u2265390\/7 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not.<\/jats:p><jats:p>\n            Results\u2003Of 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61\u20130.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61\u20130.70; p\u2009=\u20090.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21\u20130.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15\u20130.94). Other perinatal outcomes were similar between the groups.<\/jats:p><jats:p>\n            Conclusion\u2003Maternal characteristics did not predict spontaneous labor onset at \u226539 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2099-4395","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T23:14:35Z","timestamp":1684970075000},"page":"1725-1731","source":"Crossref","is-referenced-by-count":2,"title":["Predicting Spontaneous Labor beyond 39 Weeks among Low-Risk Expectantly Managed Pregnant Patients"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8263-5776","authenticated-orcid":false,"given":"Ayodeji","family":"Sanusi","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanfan","family":"Ye","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4837-8059","authenticated-orcid":false,"given":"Ashley N.","family":"Battarbee","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Sinkey","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Pearlman","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danyon","family":"Beitel","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff M.","family":"Szychowski","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan T. N.","family":"Tita","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akila","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"issue":"155","key":"ref1","first-page":"1","article-title":"Recent declines in induction of labor by gestational age","author":"M JK 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Rep"},{"issue":"26","key":"ref30","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1056\/NEJMcibr1404324","article-title":"Cell-free fetal DNA: a trigger for parturition","volume":"370","author":"M Phillippe","year":"2014","journal-title":"N Engl J Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2099-4395.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T22:35:28Z","timestamp":1698446128000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2099-4395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,24]]},"references-count":30,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,10,27]]},"published-print":{"date-parts":[[2023,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2099-4395","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,5,24]]},"published":{"date-parts":[[2023,5,24]]}}}