Maternal obesity and contraction strength in the first stage of labor

Chin, Jeannette; Henry, Erick; Holmgren, Calla; Varner, Michael W.; Branch, D. Ware

doi:10.1016/j.ajog.2012.06.044

Cited by 37 publications

(47 citation statements)

References 23 publications

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“…Despite the fact that current oxytocin protocols are not individualized by the degree of maternal obesity, maternal delivery BMI appears to predict nearly 17% of women's hourly oxytocin doses during labor augmentation. Unfortunately, currently available gold-standard techniques for monitoring contraction intensity (intrauterine pressure catheters) cannot discriminate between obese and normal-weight women's contractions in late first-stage (Chin, Henry, Holmgren, Varner, & Branch, 2012) or second-stage labor (Buhimschi, Buhimschi, Malinow, & Weiner, 2004) and thus are of questionable use for nurses wishing to determine oxytocin dose in obese women by myometrial response. Our findings suggest the need for further research upon which to base revised protocols for dosing oxytocin in obese women, including the possibilities of dosing oxytocin over longer periods of time to correct for obesity-related myometrial inefficiency, dosing oxytocin at higher levels, or some combination of these strategies.…”

Section: Discussionmentioning

confidence: 99%

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Carlson

Corwin

Lowe

2017

Biological Research For Nursing

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Background Synthetic oxytocin, the primary tool for labor augmentation, is less effective among obese women, leading to more unplanned cesarean deliveries for slow labor progress. It is not known if obese women require higher doses of oxytocin due to maternal, fetal, or labor factors related to maternal obesity. Objectives This study had two main objectives: 1) Examine the influence of maternal body mass index (BMI) on hourly doses of oxytocin from augmentation initiation until vaginal delivery in obese women; and 2) Examine the influence of other maternal, fetal, and labor factors on hourly doses of oxytocin in obese women. Study design Longitudinal study of a cohort (N = 136) of healthy, nulliparous, spontaneously laboring obese women (BMI ≥ 30 kg/m2) who received oxytocin augmentation and achieved vaginal delivery. We performed iterative multilevel analyses to examine the influence of maternal BMI and other factors on hourly oxytocin doses. Results Maternal BMI explained 16.56% (95% CI [13.7-20.04], p < 0.001) of the variance in hourly oxytocin doses received in a multilevel model controlling for influence of maternal, fetal, and labor characteristics. Maternal age, gestational age, status of amniotic membranes at hospital admission, and admission cervical dilation examination were not significant; however, neonatal birthweight and cervical dilation at oxytocin initiation were significant predictors of hourly oxytocin dose in these women (p < 0.001). Conclusions Even when parturition preparation has progressed adequately for spontaneous labor initiation, there still may be some obesity-related blunting of myometrial contractility and response to oxytocin used for augmentation.

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Section: Discussionmentioning

confidence: 99%

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Carlson

Corwin

Lowe

2017

Biological Research For Nursing

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“…One retrospective study found that while obese women received higher maximum oxytocin dosages in the first stage of labor, they were no less able to generate ''adequate'' Montevideo units (Z200) than normal-weight women. 21 It may thus be that obese women are more frequently augmented with oxytocin because of their inherently longer first stage of labor and not because of an impaired response to oxytocin, per se.…”

Section: Labor Progressionmentioning

confidence: 99%

Intrapartum Management of the Obese Gravida

Carpenter¹

2016

Clinical Obstetrics &Amp; Gynecology

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Obese women are at increased risk for multiple labor abnormalities, including postdates pregnancy, failed induction of labor, prolonged labor, cesarean delivery, and postpartum hemorrhage (PPH). Prolonged labor among obese women is confined to the first stage of labor. In the setting of reassuring fetal and maternal status, increased time to progress in the first stage of labor should be allowed. Uterine atony occurs more frequently in obese women and vigilance in the prevention of PPH is critical. There is a lack of high-quality data to guide the management of induction, labor, and PPH prevention among obese women.

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“…Con respecto a los partos instrumentales, nuestro estudio mostró que son similares en el grupo control y en el de gestantes con obesidad mórbida; esto reafirma la teoría (ya expuesta en otros artículos, como los publicados por Vahratian et al 15 , Buhimschi et al 16 o Kominiarek et al 17 , de que la obesidad hace prolongar la primera parte del parto (fase de dilatación), pero no la segunda (periodo de expulsivo) [15][16][17][18][19][20][21] .…”

Section: Discussionunclassified

“…Entre ellas podemos destacar que la obesidad hace prolongar la primera parte del parto (fase de dilatación) [15][16][17][18][19][20][21] , pero no la segunda (periodo de expulsivo), dato que debemos tener en cuenta si nos enfrentamos al parto de una mujer con obesidad. Por otra parte, la inducción es más frecuente en mujeres obesas que en no obesas 9,12,22-26 , siendo además la tasa de fallo de inducción más frecuente 26 .…”

Section: Introductionunclassified

Influencia de la obesidad en la evolución del parto

Farrona

Vilches

Jiménez

et al. 2015

Progresos de Obstetricia y Ginecología

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Recibido el 8 de diciembre de 2013; aceptado el 4 de diciembre de 2014 PALABRAS CLAVEObesidad mórbida; Embarazo; Cesárea; Inducción del parto; Índice de masa corporal Resumen Objetivo: Analizar la influencia de la obesidad mórbida en la vía y comienzo del parto. Hipótesis: La obesidad mórbida aumenta la tasa de cesáreas e inducciones. Sujetos y métodos: Se diseñó un estudio retrospectivo, descriptivo poblacional, con gestantes que dieron a luz durante el año 2012 en el Hospital Universitario Reina Sofía; fueron excluidas las gestaciones gemelares. Se incluyó en el grupo de gestantes con obesidad mórbida a aquellas con un índice de masa corporal en la primera visita de embarazo (en torno a las 8 semanas de gestación) igual o superior a 40. El resto de las gestantes se incluyeron en el grupo de gestantes control. Las variables analizadas fueron: edad, paridad, comienzo del parto y tipo de parto.Resultados: Las gestantes con obesidad mórbida tienen una tasa más elevada de cesáreas que el resto de las gestantes (36,76% vs. 18,49%), p < 0,001, al igual que un mayor porcentaje de inducciones (50,79% vs. 25,81%), p < 0,001.Conclusiones: La obesidad mórbida aumenta el riesgo de cesáreas e inducciones. ß 2013 SEGO. Publicado por Elsevier España, S.L.U. Todos los derechos reservados. KEYWORDS Morbid obesity; Pregnancy; Cesarean section; Induction of labor; Body mass index Influence of obesity on mode of delivery AbstractObjective: To analyze the influence of morbid obesity on mode of delivery and onset of labor Hypothesis: Morbid obesity increases the cesarean section and induction rates Subjects and methods: A population-based, retrospective, descriptive study was designed in women giving birth in 2012 at the Reina Sofía Hospital. Twin pregnancies were excluded. The women were classified according to body mass index (BMI) at the first prenatal visit (at around 8 weeks of gestation) into those who were morbidly obese (BMI greater than or equal to 40 kg/m 2 ) and a control group (BMI less than 40 kg/m 2 ). The variables analyzed were age, parity, onset of labor, and mode of delivery.

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Maternal obesity and contraction strength in the first stage of labor

Cited by 37 publications

References 23 publications

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Intrapartum Management of the Obese Gravida

Influencia de la obesidad en la evolución del parto

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