Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs expectant management at term

Wolfe, Heather; Timofeev, Julia; Tefera, Eshetu; Desale, Sameer; Driggers, Rita W.

doi:10.1016/j.ajog.2014.01.034

Cited by 38 publications

(41 citation statements)

References 21 publications

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“…Our study was different from previous studies since we only included morbidly obese women without other comorbidity. Similar to previous studies of the obese population, 14, 23 our study did not show an increased risk of maternal complications associated with non-medically indicated induction of labor compared with expectant management, although our study had limited power to detect a difference in rare but severe maternal complications.…”

Section: Commentsupporting

confidence: 88%

“…20, 21, 22 In obese women, data regarding the association between cesarean delivery and non-medically indicated induction of labor are conflicting. 14, 23 Wolfe et al in 2014 conducted a retrospective study of 410 obese nulliparous women (BMI ≥30 kg/m 2 ) with an unfavorable cervix, which showed elective induction of labor between 39 and 40 weeks' gestation was associated with an increased risk of cesarean delivery compared with expectant management. 14 However, Lee et al in 2015 conducted a retrospective study of 74,725 obese women (BMI ≥30 kg/m 2 ) using an administrative database, which showed elective induction of labor at 39 weeks' gestation was associated with a decreased risk of cesarean delivery compared with expectant management in both nulliparuous and multiparous women.…”

Section: Commentmentioning

confidence: 99%

“…14, 23 Wolfe et al in 2014 conducted a retrospective study of 410 obese nulliparous women (BMI ≥30 kg/m 2 ) with an unfavorable cervix, which showed elective induction of labor between 39 and 40 weeks' gestation was associated with an increased risk of cesarean delivery compared with expectant management. 14 However, Lee et al in 2015 conducted a retrospective study of 74,725 obese women (BMI ≥30 kg/m 2 ) using an administrative database, which showed elective induction of labor at 39 weeks' gestation was associated with a decreased risk of cesarean delivery compared with expectant management in both nulliparuous and multiparous women. 23 In our study of morbidly obese women without other comorbidity, the risk of cesarean delivery associated with non-medically indicated induction of labor was similar in nulliparous women at both early term and full term.…”

Section: Commentmentioning

confidence: 99%

“…A previous retrospective study of obese women (BMI ≥30 kg/m 2 ) showed elective induction of labor between 39 and 40 weeks was associated with an increased risk of cesarean delivery (40% vs. 26%) and neonatal intensive care unit (NICU) admission (18% vs. 6%) compared to expectant management. 14 Data on the rate of cesarean delivery associated with non-medically indicated induction of labor compared with expectant management in morbidly obese women are very limited. The primary aim of our study is to evaluate cesarean delivery rate associated with non-medically indicated induction of labor compared to expectant management in morbidly obese women without other comorbidities at term.…”

Section: Introductionmentioning

confidence: 99%

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Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery

Kawakita

Iqbal

Huang

et al. 2017

American Journal of Obstetrics and Gynecology

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Background The prevalence of morbid obesity (body mass index [BMI] ≥40 kg/m2 in women aged 20–39 years was 7.5% in 2009–2010. Morbid obesity is associated with an increased risk of stillbirth compared with normal BMI, especially after 39 weeks' gestation. The data regarding an increased risk of cesarean delivery associated with non-medically indicated induction of labor compared to expectant management in morbidly obese women are limited. Objective To compare the cesarean delivery rate of non-medically indicated induction of labor with expectant management in morbidly obese women without other comorbidity. Study design This was a retrospective cohort study from the Consortium on Safe Labor of morbidly obese women with singleton, cephalic gestations without previous cesarean, chronic hypertension, gestational and pregestational diabetes between 37 0/7 and 41 6/7 weeks' gestation. We examined maternal outcomes including cesarean delivery, operative delivery, third or fourth degree laceration, postpartum hemorrhage, and composite maternal outcome (any of transfusion, intensive care unit admission, venous thromboembolism). We also examined neonatal outcomes including shoulder dystocia, macrosomia (>4000 g), neonatal intensive care unit (NICU) admission, and composite neonatal outcome (5-min Apgar score <5, stillbirth, neonatal death, or asphyxia or hypoxic–ischemic encephalopathy). Adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) were calculated, controlling for maternal characteristics, hospital type, and simplified Bishop score. Analyses were conducted at early and full term (37 0/7-38 6/7 and 39 0/7-40 6/7 weeks' gestation, respectively). Women who delivered between 41 0/7 and 41 6/7 weeks' gestation were included as expectant management group. Results Of 1,894 nulliparous and 2,455 multiparous morbidly obese women, 429 (22.7%) and 791 (32.2%) had non-medically indicated induction, respectively. In nulliparas, non-medically indicated induction was not associated with increased risks of cesarean delivery and was associated with decreased risks of macrosomia (2.2% vs. 11.0%; aOR=0.24; 95%CI=0.05-0.70) at early term and decreased NICU admission (5.1% vs. 8.9%; aOR=0.59; 95%CI=0.33-0.98) at full term compared with expectant management. In multiparas, non-medically indicated induction compared with expectant management was associated with a decreased risk of macrosomia at early term (4.2% vs. 14.3%; aOR=0.30; 95%CI=0.13-0.60), cesarean delivery at full term (5.4% vs. 7.9%; aOR=0.64; 95%CI=0.41-0.98), and composite neonatal outcome (0% vs. 0.6%; aOR=0.10; 95%CI=<.01-0.89) at full term. Conclusion In morbidly obese women without other comorbidity, non-medically indicated induction was not associated with an increased risk of cesarean delivery.

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Section: Commentsupporting

confidence: 88%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery

Kawakita

Iqbal

Huang

et al. 2017

American Journal of Obstetrics and Gynecology

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“…This study found that eIOL between 39–41 weeks of gestation in nulliparous obese women with an unfavorable cervix was associated with significantly higher rates of cesarean delivery compared to expectant management, whereas rates of other maternal and neonatal morbidities were similar between groups 14 . Our results regarding cesarean delivery contrast with this work, and provide new evidence in that we were able to examine multiple levels of parity, examine weekly differences in eIOL by gestational age, and account for key confounders by performing multivariable analyses.…”

Section: Discussionmentioning

confidence: 60%

Term elective induction of labour and perinatal outcomes in obese women: retrospective cohort study

Lee

Darney

Snowden

et al. 2015

BJOG

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Objective To compare perinatal outcomes between elective induction of labor (eIOL) and expectant management in obese women. Design Retrospective cohort study. Setting Deliveries in California in 2007. Population Term, singleton, vertex, nonanomalous deliveries among obese women (n=74,725). Methods Women who underwent eIOL at 37 weeks were compared with women who were expectantly managed at that gestational age. Similar comparisons were made at 38, 39, and 40 weeks. Results were stratified by parity. Chi-square tests and multivariable logistic regression were used for statistical comparison. Main Outcome Measures Method of delivery, severe perineal lacerations, postpartum hemorrhage, chorioamnionitis, macrosomia, shoulder dystocia, brachial plexus injury, respiratory distress syndrome. Results The odds of cesarean delivery were lower among nulliparous women with eIOL at 37 weeks (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.34–0.90) and 39 weeks (OR 0.77, 95% CI 0.63–0.95) compared to expectant management. Among multiparous women with a prior vaginal delivery, eIOL at 37 (OR 0.39, 95% CI 0.24–0.64), 38 (OR 0.65, 95% CI 0.51–0.82), and 39 weeks (OR 0.67, 95% CI 0.56–0.81) was associated with lower odds of cesarean. Additionally, eIOL at 38, 39, and 40 weeks was associated with lower odds of macrosomia. There were no differences in the odds of operative vaginal delivery, lacerations, brachial plexus injury, or respiratory distress syndrome. Conclusions In obese women, term eIOL may decrease the risk of cesarean delivery, particularly in multiparas, without increasing the risks of other adverse outcomes when compared with expectant management. Tweetable Abstract Elective induction of labor in obese women does not increase risk of cesarean or other perinatal morbidities.

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Prediction of successful labor induction with very unfavorable cervix: A comparison of six scores

Tollon¹,

Blanc-Petitjean

Drumez

et al. 2022

Intl J Gynecology & Obste

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Labor induction is frequently used in contemporary obstetrics practice and its rates have continued to increase. 1 Recent studies have led to modifications of paradigms for labor induction. Indeed, labor induction at 39 weeks of pregnancy in low-risk nulliparous women results in decreased cesarean rates without increasing adverse perinatal outcomes. 2,3 However, predicting successful labor induction, which is defined as vaginal delivery, is still a challenge, especially in women with an unfavorable cervix. 4,5 Different scoring systems have been proposed to address this problem. The reference standard, the Bishop score, is based on five

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Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs expectant management at term

Cited by 38 publications

References 21 publications

Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery

Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery

Term elective induction of labour and perinatal outcomes in obese women: retrospective cohort study

Prediction of successful labor induction with very unfavorable cervix: A comparison of six scores

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