Effect of maternal BMI on labor outcomes in primigravida pregnant women

Abstract

Background This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women. Methods A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III). Results We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU). Conclusion Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.

Adipositas und Schwangerschaft – Herausforderung im klinischen Alltag

“…Adipöse Schwangere haben ein höheres Risiko für protrahierte Geburten [23,24]. Sowohl die Eröffnungs-als auch die Austreibungsperiode sind im Vergleich zu normalgewichtigen Frauen verlängert [25]. In einer Studie zeigten sich bei eingeleiteten adipösen Erstgebärenden als Hinweis auf protrahierte Geburtsverläufe ein häufigerer Bedarf an Periduralanästhesien, zusätzlich wurden intrapartal häufiger Oxytocin-Infusionen verwendet [4].…”

Maternal obesity: Perinatal implications

“…Sleep-disordered breathing increases risk for low birthweight, preterm birth, assisted vaginal deliveries, cesarean section, and neonatal intensive care unit (NICU) admissions. 61 – 63 The association with low birth weight may be neutralized in obese populations by the well-established association between obesity and fetal macrosomia. There is a growing body of evidence showing an association between perinatal depression and maternal obesity, which may affect the care an infant receives after birth.…”

“…Women with class I obesity have significantly lengthened first and second stages of labor, increased need and dosing of oxytocin, and higher incidence of second- or third-degree perineal tears. 65 The rate of hemorrhage during delivery was increased, and risk of sepsis following vaginal birth was reported to be more than 10 times as likely in obese women, but there was no significant impact on instrumental delivery. 66 , 67 Obese women that attempt trial of labor after cesarean (TOLAC) following a prior cesarean section had a higher rate of failure, and also had a greater than five-fold increase in risk of uterine rupture/dehiscence, a life-threatening risk associated with TOLAC.…”

“…There is a large body of evidence that obesity contributes to increased rates of cesarean section and subsequent impaired wound healing, and these risks increased with class of obesity. 39 , 41 , 42 , 65 , 70 – 72 The increased rate of cesarean delivery is due to failures in progress of labor as well as fetal distress. 67 Cesarean deliveries are known to have many risks, both intra- and post-operatively.…”

Perinatal Outcome in Overweight Women: An Audit

“…Further, adverse outcomes seen in foetus include macrosomia, stillbirth, prematurity and intrauterine foetal death. The effect of obesity on the foetus may extend beyond pregnancy into neonatal and childhood periods [ 6 ].…”