Objective
The objective of the study was to examine maternal and neonatal outcomes in obese
nulliparous women with an unfavorable cervix undergoing elective induction of labor
compared with expectant management after 39.0 weeks.
Study Design
This was a retrospective analysis of a cohort of nulliparous women with a vertex singleton
gestation who delivered at MedStar Washington Hospital Center from 2007 to 2012. Patients
with unfavorable cervix between 38.0 and 38.9 weeks (modified Bishop <5) and a body
mass index of 30.0 kg/m2 or greater at the time of delivery were included. Women undergoing elective induction
between 39.0 and 40.9 weeks' gestation were compared with those who were expectantly
managed beyond 39.0 weeks. Outcomes were analyzed using χ2, Student t, or Wilcoxon rank sum tests as appropriate with a significance set at P < .05.
Results
Sixty patients meeting inclusion criteria underwent elective induction of labor and
were compared with 410 patients expectantly managed beyond 39.0 weeks. The rate of
cesarean delivery was significantly higher in the electively induced group (40.0%
vs 25.9%, respectively, P = .022). Other maternal outcomes, including operative vaginal delivery, rate of third-
or fourth-degree lacerations, chorioamnionitis, postpartum hemorrhage, and a need
for a blood transfusion were similar. The neonatal intensive care unit admission rate
was higher in the electively induced group (18.3% vs 6.3%, P = .001). Birthweight, umbilical artery pH less than 7.0, and Apgar less than 7 at
5 minutes were similar.
Conclusion
Elective labor induction at term in obese nulliparous parturients carries an increased
risk of cesarean delivery and higher neonatal intensive care unit admission rate as
compared with expectant management.
Key words
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References
- Pregnancy and obesity.Obstet Gynecol Clin North Am. 2009; 36 (300, viii): 285
- ACOG Committee Opinion no. 315, September 2005. Obesity in pregnancy.Obstet Gynecol. 2005; 106: 671-675
- Obesity, pregnancy complications, and birth outcomes.Semin Reprod Med. 2012; 30: 465-471
- The maternal body mass index: a strong association with delivery route.Am J Obstet Gynecol. 2010; 203: 264.e1-264.e7
- Maternal outcomes in pregnancies complicated by obesity.Obstet Gynecol. 2005; 106: 1357-1364
- Obesity, obstetric complications and cesarean delivery rate—a population-based screening study.Am J Obstet Gynecol. 2004; 190: 1091-1097
- 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
- ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice bulletin no. 107. Induction of labor.Obstet Gynecol. 2009; 114: 386-397
- Using a simplified Bishop score to predict vaginal delivery.Obstet Gynecol. 2011; 117: 805-811
- Elective induction compared with expectant management in nulliparous women with an unfavorable cervix.Obstet Gynecol. 2011; 117: 583-587
- Elective induction compared with expectant management in nulliparous women with a favorable cervix.Obstet Gynecol. 2010; 116: 601-605
- Induction of labor and cesarean delivery by gestational age.Am J Obstet Gynecol. 2006; 195: 700-705
- Maternal and neonatal outcomes of elective induction of labor.Evid Rep Technol Assess (Full Rep). 2009; 176: 1-257
- Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term.Obstet Gynecol. 2000; 95: 917-922
- Labor progression and risk of cesarean delivery in electively induced nulliparas.Obstet Gynecol. 2005; 105: 698-704
- Labor induction and the risk of a cesarean delivery among nulliparous women at term.Obstet Gynecol. 2010; 116: 35-42
- Bishop score and risk of cesarean delivery after induction of labor in nulliparous women.Obstet Gynecol. 2005; 105: 690-697
- Risk of cesarean delivery with elective induction of labor at term in nulliparous women.Obstet Gynecol. 1999; 94: 600-607
- Cesarean delivery after elective induction in nulliparous women: the physician effect.Am J Obstet Gynecol. 2004; 191: 1511-1515
- The natural history of the normal first stage of labor.Obstet Gynecol. 2010; 115: 705-710
- The effects of obesity on the first stage of labor.Obstet Gynecol. 2012; 120: 130-135
- Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop.Obstet Gynecol. 2012; 120: 1181-1193
Article info
Publication history
Published online: February 03, 2014
Accepted:
January 21,
2014
Received in revised form:
January 5,
2014
Received:
November 21,
2013
Footnotes
Dr Wolfe is currently affiliated with the Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD.
Drs Timofeev and Driggers are currently affiliated with the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD.
The views expressed herein are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government.
The authors report no conflict of interest.
Reprints not available from the authors.
Cite this article as: Wolfe H, Timofeev J, Tefera E, et al. Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs expectant management at term. Am J Obstet Gynecol 2014;211:53.e1-5.
Identification
Copyright
Published by Elsevier Inc.
