This application for a Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to an alternative method of care for the treatment of pregnancy at term [l]. Called AMOR-IPAT: the Active Management of Risk in PreEnancy at Term, this method of care is focused on improving obstetrical outcomes by: 1) identifying risk factors for untoward obstetrical outcomes; 2) preventing the development of clinical disease by insuring, through induction if necessary, that labor and delivery occur at a calculateable optimum time for mother and fetus, and; 3) using prostaglandin products in all inductions complicated by an unfavorable cervix. This application proposes a prospective randomized controlled trial, adequately powered to identify an eight percentage point drop in cesarean section rates, to measure the impact of AMOR-IPAT on population cesarean section rates. Secondary outcomes will include rates of neonatal intensive care unit admission, low one-minute APGAR score and major maternal perineal trauma, as well as patient satisfaction and cost-effectiveness. It is anticipated, based on previous retrospective research, that, in this project, AMOR-IPAT exposure will be associated with a significant reduction in cesarean section rate, and either no change, or improvement, in other important birth outcomes. The educational component of this application, culminating in a Ph.D. in Clinical Epidemiology, will raise the candidate s capacity to design, implement, evaluate and disseminate interventions in the field of primary care obstetrics to the level of an expert. This program will integrate, through both the Prospective AMOR-IPAT Research Trial and the development of the candidate himself, the principles of preventive medicine, family practice, and clinical epidemiology with the modem obstetrical management of pregnancy at term. As such, this Mentored Patient-Oriented Research Career Development Award application provides a unique opportunity to both assist the candidate in becoming an expert independent interventional researcher and promote a new promising area of obstetrical research.
