The effect of maternal obesity on the rate of failed induction of labor

Wolfe, Katherine; Rossi, Ronald R.; Warshak, Carri R.

doi:10.1016/j.ajog.2011.03.051

Cited by 129 publications

(77 citation statements)

References 17 publications

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“…5,10–12,16 These previous studies suggest that there is a general ineffectiveness of labor progression in obese women. In support of this, we also observed a lower rate of vaginal delivery among obese women who presented in spontaneous labor prior to 41 weeks and this trend persisted among those whose labor was augmented with oxytocin.…”

Section: Resultsmentioning

confidence: 92%

“…Since obese women are known to have higher rates of labor induction, 11,12 it can be hypothesized that the overall lower rate of spontaneous delivery may be a result of increased indications for induction prior to the onset of spontaneous labor. To account for this potential confounder, we performed further analyses using a low-risk cohort, excluding women with hypertensive disorders and diabetes.…”

Section: Resultsmentioning

confidence: 99%

“…5,10–12 The mechanisms responsible for the altered labor progression in obese women are not yet clear. We hypothesize that these mechanisms may also be responsible for delaying or inhibiting spontaneous labor onset, resulting in the prolonged gestations observed in obese women.…”

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confidence: 99%

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Spontaneous Labor Onset and Outcomes in Obese Women at Term

et al. 2017

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Objective The objective of this study was to compare the rates of spontaneous labor onset and its progression in obese and nonobese women after 37 weeks. Study Design We performed a secondary analysis of a retrospective cohort of all women who were admitted for delivery at ≥ 37 weeks of gestation at a university-based tertiary care center between 2004 and 2010. The cohort was stratified by weeks of gestation at which the patient presented for delivery. The rates of spontaneous labor, vaginal delivery, and augmentation with oxytocin were compared between obese (body mass index [BMI] ≥ 30) and nonobese (BMI < 30) women. Results Obese women had lower rates of spontaneous labor than nonobese women at every gestational week (37 weeks, 6.1 vs. 9.3%, p < 0.001; 38 weeks, 12.8 vs. 19.2%, p < 0.001; 39 weeks 26.0 vs. 37.0%, p < 0.001; 40 weeks, 39.6 vs. 50.2%, p < 0.001; 41 weeks, 30.8 vs. 38.0%, p < 0.012). Among women who presented in spontaneous labor, obesity was associated with higher rates of augmentation with oxytocin and lower rates of vaginal delivery. Conclusion Obese women at or beyond 37 weeks are less likely to experience spontaneous labor compared with nonobese women. In addition, obese women presenting in spontaneous labor are less likely that nonobese women to have a vaginal delivery at 37 to 40 weeks, even after oxytocin augmentation.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

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Spontaneous Labor Onset and Outcomes in Obese Women at Term

et al. 2017

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“…Limited data suggest that risk of cesarean delivery after IOL decreases with advancing gestational age at preterm gestations (42, 43). Obese women are more likely to undergo a cesarean delivery during labor and experience post-cesarean complications including infection (44, 45). It is worth considering then if obese women, particularly women with a BMI ≥50 kg/m 2 , should be delivered by prelabor cesarean to allow a controlled delivery, perhaps in a center with adequate anesthesia personnel and equipment.…”

Section: Discussionmentioning

confidence: 99%

Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term

Tolcher

Holbert

Weaver

et al. 2015

Obstetrics &Amp; Gynecology

144

114

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OBJECTIVES To identify independent risk factors for cesarean delivery after induction of labor (IOL) and to develop a nomogram for predicting cesarean delivery among nulliparous women undergoing IOL at term. METHODS This is a retrospective cohort study including nulliparous women with singleton, term (≥37 0/7 weeks of gestation), cephalic pregnancies undergoing IOL from July 1, 2006, through May 31, 2012, at a tertiary care academic center. Inductions were identified using ICD-9 codes. Demographic, delivery, and outcome data were abstracted manually from the medical record. Women with a contraindication to vaginal delivery (malpresentation, abnormal placentation, prior myomectomy) were excluded. Independent risk factors for cesarean delivery were identified using logistic regression. RESULTS During the study period, there were 785 nulliparous inductions who met study criteria; 231 (29.4%) underwent cesarean delivery. Independent risk factors associated with an increased risk of cesarean delivery included older maternal age, shorter maternal height, greater body mass index, greater weight gain during pregnancy, older gestational age, hypertension, diabetes mellitus, and initial cervical dilation <3 cm. A nomogram was constructed based on the final model with a bias-corrected c-index of 0.709 (95% CI 0.671–0.750). CONCLUSION We identified independent risk factors which can be utilized to predict cesarean delivery among nulliparous women undergoing IOL at term. If validated in other populations, the nomogram could be useful for individualized counseling of women with a combination of identifiable antepartum risk factors.

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“…8 Multiple observational studies of induction of labor in the general population showed an increased risk of cesarean delivery compared to spontaneous labor. 9-13 Because women cannot choose to enter spontaneous labor, the ideal comparison group for labor induction is women undergoing expectant management.…”

Section: Introductionmentioning

confidence: 99%

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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The effect of maternal obesity on the rate of failed induction of labor

Cited by 129 publications

References 17 publications

Spontaneous Labor Onset and Outcomes in Obese Women at Term

Spontaneous Labor Onset and Outcomes in Obese Women at Term

Predicting Cesarean Delivery After Induction of Labor Among Nulliparous Women at Term

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

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