{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T15:54:06Z","timestamp":1721058846038},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>\n            Objective\u2003The aim of the study is to evaluate differences in maternal and neonatal outcomes based on updated criteria for defining active labor at 6\u2009cm of cervical dilation and to determine if these recommendations are cost-effective.<\/jats:p><jats:p>\n            Study Design\u2003A decision-analytic model was built using TreeAge Pro 2020 software. We included maternal outcomes of mode of delivery, endometritis, postpartum hemorrhage requiring transfusion, and death. Neonatal outcomes included rates of shoulder dystocia and permanent brachial plexus injury. Costs and quality-adjusted life years (QALYs) were included from the maternal and infant perspectives. We used a willingness-to-pay threshold of $100,000 per QALY and all model inputs were subjected to sensitivity analysis.<\/jats:p><jats:p>\n            Results\u2003In a theoretical cohort of 1.4 million women, a threshold of 6\u2009cm to define active labor resulted in 373,668 fewer cesarean deliveries, 33,181 fewer cases of endometritis, 143 fewer postpartum hemorrhages requiring transfusions, and seven fewer maternal deaths when compared with a threshold of 4\u2009cm. However, there were higher rates of adverse neonatal outcomes, including 484 more cases of shoulder dystocia and 17 more instances of permanent brachial plexus injury. Using 6\u2009cm as the threshold resulted in lower costs and greater effectiveness, making it a dominant strategy. Multivariate sensitivity analysis demonstrated the model was robust over a wide range of assumptions.<\/jats:p><jats:p>\n            Conclusion\u2003In this model, considering 6\u2009cm of cervical dilation as the threshold for the active phase of labor compared with 4\u2009cm was a cost-effective strategy to prevent primary cesarean deliveries, lower costs, and improve maternal outcomes, despite associated increased adverse neonatal outcomes.<\/jats:p><jats:p>\n            Key Pointsg\n          <\/jats:p>","DOI":"10.1055\/s-0041-1728836","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T22:52:08Z","timestamp":1620082328000},"page":"099-105","source":"Crossref","is-referenced-by-count":1,"title":["Considering Criteria for Active Phase Labor Management of Nulliparous Women: A Cost-Effectiveness Analysis"],"prefix":"10.1055","volume":"40","author":[{"given":"Eleanor M.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa R.","family":"Hersh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Methodius","family":"Tuuli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison G.","family":"Cahill","sequence":"additional","affiliation":[{"name":"Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron B.","family":"Caughey","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Oregon Health and Science 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