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Data are limited regarding contributors for the increase in cesarean delivery (CD) in obese women. We investigated the indications for primary CD by body mass index kg/m2 (BMI) category.
In the Consortium of Safe Labor study (2002-2008), we calculated indications for primary CD including multiple gestation, malpresentation, elective, macrosomia, placenta previa or vasa previa, fetal indication, human immunodeficiency virus (HIV) or active herpes simplex virus (HSV), uterine scar, nonreassuring fetal heart tracing (NRFHT), chorioamnionitis, placental abruption, hypertensive disease (HTN), failure to progress or cephalopelvic disproportion (FTP or CPD), failed induction, and failed operative delivery. We excluded previous CD, antepartum stillbirth, congenital anomaly, and BMI <18.5. Women were categorized according to BMI: normal weight (18.5-24.9), overweight (25.0-29.9), obese category I (30.0-34.9), category II (35.0-39.9), and category III (≥40). Chi-square and Cochran-Armitage Trend Test were used to compare indications. P-value (P) <.01 was considered as significant.
Of 66,502 nulliparas and 76,961 multiparas, 19,431 nulliparas (29.2%) and 7,329 multiparas (9.5%) underwent primary CD. In nulliparas, higher BMI was associated with increased rates of primary CD for elective, macrosomia, fetal indication, NRFHT, chorioamnionitis, HTN, FTP or CPD, and failed induction (P<.01 for all) but not for malpresentation (P=.02), multiple gestation (P=.03), HIV or active HSV (P=.70), uterine scar (P=.02), placental abruption (P=.05), and failed operative delivery (P=.27) (Figure 1). In multiparas, higher BMI was associated with increased rates of primary CD for malpresentation, elective, multiple gestation, macrosomia, fetal indication, NRFHT, HTN, FTP or CPD, and failed induction (P<.01 for all) but not for HIV or active HSV (P=.31), uterine scar (P=.07), chorioamnionitis (P=.06), placental abruption (P=.14), and failed operative delivery (P=.91) (Figure 2). Higher BMI was associated with decreased rate of primary CD for placenta previa or vasa previa regardless of parity (P<.01).
NRFHT and FTP or CPD were major contributors for the increased primary CD rates in obese women. Further evaluation is needed to attempt to reduce the CD rate.