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Grand Rounds

Does Elective Induction Lower Risk for Adverse Obstetrical Outcomes in the Setting of Obesity

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BACKGROUND AND PURPOSE:

  • Standardized guidelines for management of women with BMI ≥30 in pregnancy are not currently available
  • Gibbs Pickens et al. (Obstetrics & Gynecology, 2017) compared elective induction vs expectant management to assess impact on cesarean delivery and adverse perinatal outcomes in obese women, 39-41 weeks

METHODS:

  • Retrospective cohort study (2007-2011)
  • California Linked Patient Discharge Data–Birth Cohort File
  • Inclusion: Singleton, cephalic, nonanomalous deliveries to obese women, ≥39 weeks
  • Exclusion: Pre-existing medical conditions, previous cesarean, abnormal placentation, issoimmunization
  • Multivariable logistic regression models were used, stratified by parity for each week from 39 to 41 weeks
  • Primary outcome
    • Maternal mode of delivery
  • Secondary outcomes
    • Severe maternal morbidity (composite outcome)
    • Macrosomia (birth weight ≥4,500 g)
    • Shoulder dystocia, brachial plexus injury
    • Clinical chorioamnionitis
    • Infant mortality, NICU admission, neonatal transfer or extended hospital stay, meconium aspiration syndrome, respiratory distress syndrome (RDS)

RESULTS:

  • 165,975 women were included
  • Among nulliparous, obese women, cesarean section was less common at 39 and 40 weeks in the induction group
  • Cesarean section was 35.9% in the induction group vs 41.0% in the expectant management group
    • 39 weeks: Adjusted odds ratio [OR] 0.82; 95% CI 0.77–0.88
  • Severe maternal morbidity was less common among nulliparous women undergoing induction (5.6%) vs expectant management (7.6%)
    • 39 weeks: Adjusted OR 0.75; 95% CI 0.65–0.87
  • NICU admission was reduced among nulliparous women undergoing induction (7.9%) when compared to expectant management (10.1%)
    • 39 weeks: Adjusted OR 0.79; 95% CI 0.70-0.89
  • Benefits of induction were also seen in parous women when induction was compared to expectant management (following data at 39 weeks)
    • Cesarean delivery less common: 7.0% vs 8.7%
      • OR 0.79; 95% CI 0.73–0.86
    • Severe maternal morbidity less common: 3.3% vs 4.0%
      • OR 0.83; 95% CI 0.74–0.94
    • NICU admission less common: 5.3% vs 7.4%
      • OR 0.75; 95% CI 0.68–0.82
    • Similar findings were found at 40 weeks with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients

CONCLUSION:

  • Elective labor induction in obese women was associated with lower risk for maternal and neonatal morbidity
  • Authors recommend future research with more rigorous (prospective) study design

Learn More – Primary Sources:

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

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Related ObG Topics:

Maternal Overweight, Obesity and Congenital Malformations – How Strong is the Link?
Obesity in Pregnancy: Classification and Clinical Implications
Obesity and Stillbirth At Term – What is the Actual Risk?
Increasing BMI and Adverse Pregnancy Outcomes: What Are the Risks?

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