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Predictors of failed trial of labor among women with an extremely obese body mass index

      Objective

      The purpose of this study was to examine predictors associated with cesarean delivery (CD) among extremely obese women undergoing a trial of labor (TOL).

      Study design

      Using a delivery database, we identified all pregnant women delivering at our institution from Jan. 1, 2008, through July 31, 2010, weighing >275 lb at the time of delivery who attempted a TOL with a singleton gestation >34 weeks' gestation. Demographic and obstetrical factors were compared for those having a successful vaginal delivery to those having a CD.

      Results

      During the study period, there were 357 pregnant women who weighed >275 lb (all with body mass index [BMI] >40 kg/m2), and among these, 248 (69.5%) attempted a TOL. Women having a CD had a greater BMI (51.6 vs 49.9 kg/m2, P = .038), were less likely to be parous (32.2% vs 65.8%, P < .0001), and were more likely to be induced (80.5% vs 57.8%) compared to those having a vaginal delivery. Using a multivariable logistic regression model, among nulliparous women, maternal age, parity, and cervical dilation at time of admission were independent predictors for CD. Furthermore, an increase in BMI of 10 kg/m2 was associated with a 3.5 increased odds (P = .002) for CD.

      Conclusion

      Among nulliparous extremely obese women attempting a TOL, BMI was an independent predictor of CD, with the rate of CD increasing further with increasing BMI. The underlying mechanisms for failed TOL in the setting of maternal obesity remain largely unknown.

      Key words

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      References

        • Flegal K.M.
        • Carroll M.D.
        • Kit B.K.
        • Ogden C.L.
        Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.
        JAMA. 2012; 307: 491-497
      1. Obesity: preventing and managing the global epidemic; report of a WHO consultation.
        World Health Organ Tech Rep Ser. 2000; 894 (1-253): i-xii
        • Marshall N.E.
        • Guild C.
        • Cheng Y.W.
        • Caughey A.B.
        • Halloran D.R.
        Maternal superobesity and perinatal outcomes.
        Am J Obstet Gynecol. 2012; 206: 417.e1-417.e6
        • Alanis M.C.
        • Villers M.S.
        • Law T.L.
        • Steadman E.M.
        • Robinson C.J.
        Complications of cesarean delivery in the massively obese parturient.
        Am J Obstet Gynecol. 2010; 203: 271.e1-271.e7
        • Wolfe K.B.
        • Rossi R.A.
        • Warshak C.R.
        The effect of maternal obesity on the rate of failed induction of labor.
        Am J Obstet Gynecol. 2011; 205: 128.e1-128.e7
        • Nuthalapaty F.S.
        • Rouse D.J.
        • Owen J.
        The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction.
        Obstet Gynecol. 2004; 103: 452-456
        • Pevzner L.
        • Powers B.L.
        • Rayburn W.F.
        • Rumney P.
        • Wing D.A.
        Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction.
        Obstet Gynecol. 2009; 114: 1315-1321
        • Ehrenberg H.M.
        • Iams J.D.
        • Goldenberg R.L.
        • et al.
        Maternal obesity, uterine activity, and the risk of spontaneous preterm birth.
        Obstet Gynecol. 2009; 113: 48-52
        • Myles T.D.
        • Gooch J.
        • Santolaya J.
        Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery.
        Obstet Gynecol. 2002; 100: 959-964
        • Allen V.M.
        • O'Connell C.M.
        • Liston R.M.
        • Baskett T.F.
        Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term.
        Obstet Gynecol. 2003; 102: 477-482
        • Conroy K.
        • Koenig A.F.
        • Yu Y.H.
        • Courtney A.
        • Lee H.J.
        • Norwitz E.R.
        Infectious morbidity after cesarean delivery: 10 strategies to reduce risk.
        Rev Obstet Gynecol. 2012; 5: 69-77
        • Butwick A.
        • Carvalho B.
        • Danial C.
        • Riley E.
        Retrospective analysis of anesthetic interventions for obese patients undergoing elective cesarean delivery.
        J Clin Anesth. 2010; 22: 519-526
        • Harper L.M.
        • Caughey A.B.
        • Odibo A.O.
        • Roehl K.A.
        • Zhao Q.
        • Cahill A.G.
        Normal progress of induced labor.
        Obstet Gynecol. 2012; 119: 1113-1118
        • Rouse D.J.
        • Owen J.
        • Hauth J.C.
        Criteria for failed labor induction: prospective evaluation of a standardized protocol.
        Obstet Gynecol. 2000; 96: 671-677
        • Vahratian A.
        • Zhang J.
        • Troendle J.F.
        • Savitz D.A.
        • Siega-Riz A.M.
        Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women.
        Obstet Gynecol. 2004; 104: 943-951
        • Maslow A.S.
        • Sweeny A.L.
        Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term.
        Obstet Gynecol. 2000; 95: 917-922
        • Zhang J.
        • Troendle J.
        • Mikolajczyk R.
        • Sundaram R.
        • Beaver J.
        • Fraser W.
        The natural history of the normal first stage of labor.
        Obstet Gynecol. 2010; 115: 705-710
        • Weiss J.L.
        • Malone F.D.
        • Emig D.
        • et al.
        Obesity, obstetric complications and cesarean delivery rate–a population-based screening study.
        Am J Obstet Gynecol. 2004; 190: 1091-1097
        • Fyfe E.M.
        • Anderson N.H.
        • North R.A.
        • et al.
        Risk of first-stage and second-stage cesarean delivery by maternal body mass index among nulliparous women in labor at term.
        Obstet Gynecol. 2011; 117: 1315-1322
        • Robinson B.K.
        • Mapp D.C.
        • Bloom S.L.
        • et al.
        Increasing maternal body mass index and characteristics of the second stage of labor.
        Obstet Gynecol. 2011; 118: 1309-1313
        • Hoffman M.K.
        • Vahratian A.
        • Sciscione A.C.
        • Troendle J.F.
        • Zhang J.
        Comparison of labor progression between induced and noninduced multiparous women.
        Obstet Gynecol. 2006; 107: 1029-1034
        • Heffner L.J.
        • Elkin E.
        • Fretts R.C.
        Impact of labor induction, gestational age, and maternal age on cesarean delivery rates.
        Obstet Gynecol. 2003; 102: 287-293
        • Grotegut C.A.
        • Gunatilake R.P.
        • Feng L.
        • Heine R.P.
        • Murtha A.P.
        The influence of maternal body mass index on myometrial oxytocin receptor expression in pregnancy.
        Reprod Sci. 2013 May 7; ([Epub ahead of print])
        • Chin J.R.
        • Henry E.
        • Holmgren C.M.
        • Varner M.W.
        • Branch D.W.
        Maternal obesity and contraction strength in the first stage of labor.
        Am J Obstet Gynecol. 2012; 207: 129.e1-129.e6