FPIN's Help Desk Answers
Maternal Obesity and Labor Induction
Am Fam Physician. 2018 May 15;97(10):671-672.
Is maternal obesity associated with failure of induction of labor?
Pregnant women who are obese have nearly double the rate of cesarean delivery, and obesity increases the median duration of active labor by up to four hours when labor is induced. The difference in cesarean delivery rate is larger in obese primigravida patients presenting with cervical dilation of less than 1 cm. (Strength of Recommendation: B, based on a secondary analysis of a randomized controlled trial and cohort studies.)
A 2009 secondary analysis of data from a previous double-blind randomized controlled trial compared two types of vaginal prostaglandins.1 The study included 1,273 women requiring cervical ripening (Bishop score less than 5). They were stratified by body mass index (BMI) into lean, obese, and extremely obese (BMI less than 30 kg per m2, 30 to 39.9 kg per m2, and 40 kg per m2 or more, respectively). Patients were older than 17 years with singleton pregnancies of at least 36 weeks' gestation, less than four previous deliveries, and no previous cesarean deliveries. Intravaginal dinoprostone (Cervidil) or misoprostol (Cytotec) was used for cervical ripening. Rates of cesarean deliveries for any indication were 21% in the lean group, 30% in the obese group (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.2 to 2.1), and 37% in the extremely obese group (OR = 2.1; 95% CI, 1.5 to 3.5). Median duration of active labor was significantly longer in both obese groups (16 hours in obese and 19 hours in very obese, compared with 15 hours in the lean group (P < .001 for both comparisons). This was confirmed after adjusting for race, parity, and type of prostaglandin used.
A 2015 retrospective cohort study of 7,543 women with singleton term pregnancies undergoing labor induction examined the association between BMI and cesarean delivery rate.2 Indications for induction were classified as maternal, fetoplacental, postdates, rupture of membranes,
1. Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA. Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstet Gynecol. 2009;114(6):1315–1321.
2. Ronzoni S, Rosen H, Melamed N, Porat S, Farine D, Maxwell C. Maternal obesity class as a predictor of induction failure: a practical risk assessment tool. Am J Perinatol. 2015;32(14):1298–1304.
3. O'Dwyer V, O'Kelly S, Monaghan B, Rowan A, Farah N, Turner MJ. Maternal obesity and induction of labor. Acta Obstet Gynecol Scand. 2013;92(12):1414–1418.
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