Intrapartum Management of the Obese Gravida

Carpenter, John E.

doi:10.1097/grf.0000000000000174

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…After adjustment, the outcomes persisted in the groups with BMI 25-29.9 and 30-34.9. This result is consistent with the results of previous studies [10, 11,13,14,16]. There were less women in G4 compared to the other BMI groups, which could explain why the result isn't significant for these women,.…”

Section: Discussionsupporting

confidence: 92%

“…Overweight and obesity are also associated with longer periods of active labor [14]. For cervical ripening and reaching active labor, studies have shown that obese women have a different course of labor compared with women with a normal weight (BMI <25) [7,9,10,13,14]. Cervical ripening is slower, which means that it takes longer to reach the active phase of labor and that they may need more doses of prostaglandins during IOL.…”

Section: Introductionmentioning

confidence: 99%

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Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study

2022

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Background Obesity is increasing in Sweden and is also of huge global concern. Obesity increases the risk of complications during pregnancy and the need for the induction of labor. Induction of labor increases the number of complications during delivery, leading to women with more negative birth experience. This study investigated how maternal body mass index (BMI) during antenatal care enrollment affects labor outcomes (proportion of cesarean section at induction of labor). Method This was a retrospective cohort study of 3772 women with mixed parity and induction of labor at Soderhospital, Stockholm, in 2009–2010 and 2012–2013. The inclusion criteria were simplex, ≥34 gestational weeks, cephalic presentation and no previous cesarean section. The women were grouped according to BMI, and statistical analyzes were performed to compare the proportion of cesarean sections after induction of labor. The primary outcome was the proportion of cesarean section after induction of labor divided by group of maternal BMI. The secondary outcomes were postpartum hemorrhage >1000 ml, time of labor, fetal outcome data, and indication for emergency cesarean section. Result The induction of labor in women with a high BMI resulted in a significantly increased risk of cesarean section, with 18.4–24.1% of deliveries, depending on the BMI group. This outcome persisted after adjustment in women with BMI 25–29.9 (aOR 1.4; 95% CI; 1.1–1.7) and BMI 30–34.9 (aOR 1.5; 95% CI; 1.1–2.1). There was also a significantly higher risk for CS among primiparous women (aOR 3.6; 95% CI; 2.9–45) and if the newborn weighted ≥ four kilos (aOR 1.6; 95% CI; 1.3–2.0). Conclusion Our findings show that a higher BMI increased the risk of cesarean section after induction of labor in the groups with BMI 25–34.9. Parity seems to be the strongest risk factor for CS regardless other variables.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study

2022

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“…Furthermore, it was discovered that apelin has the capacity to inhibit spontaneous and oxytocin-induced uterine contractility [244]. The authors speculated that generally higher apelin concentrations in obese individuals might be responsible for the reduction of uterine contractility in vivo, which put them at increased risk multiple labor complications [244,245]. It was proposed that prolonged fasting could lead to elevation of circulating apelin levels during gestation [246].…”

Section: Other Gestational Complicationsmentioning

confidence: 99%

The Role of the Adipokines in the Most Common Gestational Complications

Gutaj

Sibiak

Jankowski

et al. 2020

IJMS

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Adipocytokines are hormonally active molecules that are believed to play a key role in the regulation of crucial biological processes in the human body. Numerous experimental studies established significant alterations in the adipokine secretion patterns throughout pregnancy. The exact etiology of various gestational complications, such as gestational diabetes, preeclampsia, and fetal growth abnormalities, needs to be fully elucidated. The discovery of adipokines raised questions about their potential contribution to the molecular pathophysiology of those diseases. Multiple studies analyzed their local mRNA expression and circulating protein levels. However, most studies report conflicting results. Several adipokines such as leptin, resistin, irisin, apelin, chemerin, and omentin were proposed as potential novel early markers of heterogeneous gestational complications. The inclusion of the adipokines in the standard predictive multifactorial models could improve their prognostic values. Nonetheless, their independent diagnostic value is mostly insufficient to be implemented into standard clinical practice. Routine assessments of adipokine levels during pregnancy are not recommended in the management of both normal and complicated pregnancies. Based on the animal models (e.g., apelin and its receptors in the rodent preeclampsia models), future implementation of adipokines and their receptors as new therapeutic targets appears promising but requires further validation in humans.

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“…Maternal obesity is a known risk factor for Cesarean delivery in both developed and developing countries; the OR for obese women having a CS delivery compared with women of normal weight is 2.01–2.36 ( 68 , 92 – 97 ). High maternal BMI is associated with an increased risk for failed labor, which in turn increases labor duration and ultimately leads to CS delivery ( 68 , 92 , 98 ).…”

Section: Confounding Factorsmentioning

confidence: 99%

A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome

2018

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Numerous studies suggest that infants delivered by cesarean section are at a greater risk of non-communicable diseases than their vaginal counterparts. In particular, epidemiological studies have linked Cesarean delivery with increased rates of asthma, allergies, autoimmune disorders, and obesity. Mode of delivery has also been associated with differences in the infant microbiome. It has been suggested that these differences are attributable to the “bacterial baptism” of vaginal birth, which is bypassed in cesarean deliveries, and that the abnormal establishment of the early-life microbiome is the mediator of later-life adverse outcomes observed in cesarean delivered infants. This has led to the increasingly popular practice of “vaginal seeding”: the iatrogenic transfer of vaginal microbiota to the neonate to promote establishment of a “normal” infant microbiome. In this review, we summarize and critically appraise the current evidence for a causal association between Cesarean delivery and neonatal dysbiosis. We suggest that, while Cesarean delivery is certainly associated with alterations in the infant microbiome, the lack of exposure to vaginal microbiota is unlikely to be a major contributing factor. Instead, it is likely that indication for Cesarean delivery, intrapartum antibiotic administration, absence of labor, differences in breastfeeding behaviors, maternal obesity, and gestational age are major drivers of the Cesarean delivery microbial phenotype. We, therefore, call into question the rationale for “vaginal seeding” and support calls for the halting of this practice until robust evidence of need, efficacy, and safety is available.

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Intrapartum Management of the Obese Gravida

Cited by 15 publications

References 34 publications

Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study

Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study

The Role of the Adipokines in the Most Common Gestational Complications

A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome

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