Risk factors for failed induction of labor among pregnant women with Class III obesity

Abstract

| INTRODUC TI ONObesity and overweight are currently a public health problem in France. The World Health Organization has described obesity according to three increasing classes of severity as a function of body mass index (BMI), Class I (30-34.9 kg/m 2 ), Class II (35-39.9 kg/m 2 ) and Class III (≥40 kg/m 2 ). This description is correlated with the numbers and severity of complications observed in these populations. The specific and nonspecific complications of obesity are numerous. Cardiovascular complications are those responsible for the highest morbidity. 1 In obstetrics, obesity leads to the risk of complications (preeclampsia, gestational diabetes, pregnancy-induced Abstract Introduction: Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. Material and methods: This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m 2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. Results: In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. Conclusions: In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score. K E Y W O R D S cesarean delivery, induction of labor, morbid obesity, obesity, pregnancy, vaginal delivery

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review

“…As a result these women are more likely to require labour induction 83 . However, induction is less likely to succeed and obese women are more than 3-times more likely than normal weight women to require an emergency caesarean after induction [83][84][85] .…”

“…83 However, induction is less likely to succeed and obese women are more than F I G U R E 3 Factors that contribute to risk of pre-eclampsia (PE) and disease progression three-fold more likely than normal weight women to require an emergency caesarean after induction. [83][84][85] Intervention in labour is overall more likely in obese women, who are less likely than women of ideal weight to have a spontaneous vaginal delivery. 86 The most likely intervention is caesarean section (both elective and emergency).…”

Caesarean sections and outcomes of labor induction after the introduction of a new intravaginal device: retrospective analysis

“…More than half the women (53.2%) were in their first pregnancy. Fifty two percent underwent labour induction in either the 40th week (62, 36.3%) or 41st week (27,15.8%) of pregnancy. A large majority were non-smokers (158, 92.4%).…”

“…This is even more striking considering the study population was comprised of somewhat obese women (48.5% had a BMI >30 at delivery) and for about half the women it was their first pregnancy. Both are very unfavorable factors for labour induction according to the medical literature [15]. Data from the NPIS show that 70% of pregnant Slovenian women have a normal BMI at the time of pregnancy, 18% are overweight and 8% are obese [16].…”

Incidence of obese parturients and the outcomes of their pregnancies: A nationwide register study in Finland

“…Furthermore, infertility is more common in obese women [20]. Acute complications associated with obesity include preeclampsia, macrosomia, preterm birth, difficulties in labor induction, and prolonged labor [6,7,14,21,22]. These factors may explain the high rate of labor induction and at least some of the increased risk of CS among morbidly obese parturients (a two-fold increase in the rates of elective and urgent CS, though emergency CS rates were in line with the other groups).…”