Are Women with Obesity at Increased Risk for Failed Induction of Labor?
BACKGROUND AND PURPOSE:
Women with obesity undergoing labor induction have a high risk of cesarean delivery
Unclear if variation in management may account for this finding
Hamm et al. (American Journal of Perinatology, 2021) compared cesarean rates among women with and without obesity undergoing a strict labor induction protocol
Secondary analysis of a randomized trial of induction methods
Performed between May 2013 to June 2015
Participants in initial RCT
Term pregnancies: ≥37 weeks
Undergoing induction with an unfavorable cervix (Bishop’s score ≤6 and dilation ≤2 cm)
Obesity: BMI (≥30 kg/m2)
Nonobesity: BMI (<30 kg/ m2)
This trial utilized a labor protocol that standardized induction and active labor management, with recommendations for interventions at particular time points
Only variable in the initial study was cervical ripening method
Sample size calculation
Fixed sample size: 491
Baseline cesarean rate: 25%
>80% power to detect a 1.5-fold difference in cesarean delivery
Obesity: 207 women | Nonobesity: 258 women
Even after adjustment for parity, weight change over pregnancy, and indication for induction, women with obesity had a higher risk of cesarean (P=0.02)
Adjusted relative risk 1.79 (95% CI, 1.34 to 2.39)
Women with obesity had a higher risk of failed induction (P=0.01)
No differences were detected for the following
Arrest of active phase (P=0.39)
Arrest of descent (P=0.95)
Fetal indication (P=0.32)
Even when using a standardized labor protocol, women with obesity undergoing induction of labor were at a higher risk of cesarean delivery, particularly through failed induction
Hypotheses to explain this finding include decreased myometrial contractility possibly due to hormonal differences
Sample size did not allow for stratifying by BMI class
The authors conclude
While we are beginning to understand the unique physiology of labor and induction in women with obesity from a basic science perspective, the results of this study support the need for additional research
Translational work to develop interventions that target differences in physiology for women with obesity may be beneficial
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