A comparison of cervical ripening modalities among overweight and obese nulliparous gravidas

Sarumi, Mojirayo; Gherman, Robert B.; Bell, Theodore; Jairath, Puneet; Johnson, Martin H.; Burgess, Adriane

doi:10.1080/14767058.2019.1586877

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…21 In studies comparing different induction methods in women with obesity the overall cesarean section rates were high (26% up to 51.3%) and the results between methods of priming were diverse. [22][23][24][25][26][27] We found that one of five women with obesity allocated to a Foley catheter had a change of induction method, of which in 41% was because of failed placement of the Foley catheter. This number was two times higher than in women without obesity, who had a change of induction method of 10.0% (32% because of failed placement).…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

“…Grange et al., 25 in a prospective and retrospective cohort study ( n = 92), compared induction of labor of women with obesity with a double‐balloon catheter vs vaginal dinoprostone and concluded the double‐balloon catheter to be more efficient than vaginal dinoprostone after 24 hours of priming in terms of a favorable cervix; the cesarean section rate was high but not significantly different (39.1% in both groups). Sarumi et al 27 . compared dinoprostone (vaginal), misoprostol (oral and vaginal) and cervical catheters (both single and double balloon catheters) among nulliparous women with obesity and overweight nulliparous women and found a lower, although nonsignificant cesarean section rate in dinoprostone (dinoprostone 22.9%, misoprostol 33.3% and single/double balloon catheter 32.0%; P = 0.342); the odds ratios were not described.…”

Section: Discussionmentioning

confidence: 99%

“…In studies comparing different induction methods in women with obesity the overall cesarean section rates were high (26% up to 51.3%) and the results between methods of priming were diverse. 22 , 23 , 24 , 25 , 26 , 27 An RCT by Viteri et al. compared a transcervical Foley plus vaginal misoprostol to vaginal misoprostol alone in nulliparous women with obesity and found no difference in cesarean section rates (Foley and PGE1 vs PGE1 alone: 45.1% vs 43.1%, RR 1.03, 95% CI 0.75–1.42; P = 0.84).…”

Section: Discussionmentioning

confidence: 99%

“…It showed a higher BMI was associated with an increased risk of postdate pregnancy and an increased induction of labor rate. A total of 43.6% of women with morbid obesity (BMI >40) required induction (n = 603) compared with 34.4% of women with obesity (BMI 30-35) (n = 3061), 30.5% of overweight women (BMI [25][26][27][28][29][30] (n = 2051) and 26.2% of women with a normal weight (BMI [20][21][22][23][24][25] (n = 9530). 13 In the last decade the induction of labor rate in Dutch pregnant women has increased significantly, from 16.2% in 2009 to 27.5% in 2021.…”

Section: Introductionmentioning

confidence: 99%

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Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials

Croll,

De Vaan,

Moes

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionObesity is an increasing public health concern worldwide and can lead to more complications in pregnancy and childbirth. Women with obesity more often require induction of labor for various indications. The aim of this study is to assess which method of induction of labor is safest and most effective in women with obesity.Material and methodsThis is a secondary analysis of two randomized controlled trials about induction of labor. Women with a term singleton pregnancy in cephalic presentation, an unfavorable cervix, intact membranes and without a previous cesarean section were randomly allocated to cervical priming with a Foley catheter or vaginal prostaglandin‐E2‐gel (PROBAAT‐I) or a Foley catheter or oral misoprostol (PROBAAT‐II). The inclusion and exclusion criteria for the studies were identical. Induction methods were compared in women with obesity (body mass index ≥30.0). Main outcomes were cesarean section and postpartum hemorrhage (blood loss >1000 mL).ResultsA total of 2664 women, were included in the trials, 517 of whom were obese: 254 women with obesity received a Foley catheter, 176 oral misoprostol and 87 prostaglandin E2 (PGE2). A cesarean section was performed in 29.1% of women allocated to Foley vs 22.2% in the misoprostol and 23.0% in the PGE2 groups. Comparisons between groups revealed no statistically significant differences: the relative risk [RR] was 1.31 (95% confidence interval [CI] 0.94–1.84) in the Foley vs misoprostol group and 1.27 (95% CI 0.83–1.95) in the Foley vs PGE2 group. The rates of postpartum hemorrhage were comparable (10.6%, 11.4% and 6.9%, respectively; P = 0.512). In women with obesity, more often a switch to another method occurred in the Foley group, (20.1% vs 6.3% in misoprostol vs 1.1% in the PGE2 group; P < 0.001). The risk of a failed Foley placement was higher in women with obesity than in women without obesity (8.3% vs 3.2%; adjusted odds ratio 3.12, 95% CI 1.65–5.90).ConclusionsIn women with obesity we found a nonsignificant trend towards an increased rate of cesarean sections in the group induced with a Foley catheter compared to oral misoprostol; however, the study lacked power for this subgroup analysis. The finding of a higher risk of failed placement of a Foley catheter in women with obesity can be used in shared decision making.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials

Croll,

De Vaan,

Moes

et al. 2024

Acta Obstet Gynecol Scand

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Cervical ripening balloon compared with vaginal dinoprostone for cervical ripening in obese women at term: A prospective cohort study

Ducarme,

Gilman,

Sauvee

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo evaluate vaginal delivery in obese women who underwent cervical ripening at term using a dinoprostone vaginal insert or a cervical ripening balloon (CRB), and to assess maternal and neonatal morbidity according to the method.MethodsA prospective cohort study including obese women with a live singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a dinoprostone vaginal insert or a CRB. The primary outcome was vaginal delivery. Secondary outcomes were a favorable cervix (Bishop score >6) after 24 h, the time from device insertion to delivery, and composite maternal and neonatal morbidity.ResultsIn total, 135 consecutive women were analyzed (107 CRB, 79.3%; 28 dinoprostone vaginal insert, 20.7%). Vaginal delivery (86 [80.4%] after CRB vs 19 [67.9%] after dinoprostone vaginal insert; P = 0.248), favorable cervix within 24 h after device placement (52 [48.6%] vs 17 [60.7%]; P = 0.264), and maternal morbidity (12 [11.2%] vs 4 [14.3%]; P = 0.646) were similar between the groups. The time from device insertion to delivery also did not differ between the groups. Neonatal morbidity was significantly higher after the dinoprostone vaginal insert (11 [39.3%] vs 20 [18.7%]; P = 0.030). Cervical ripening using the dinoprostone vaginal insert, compared with the CRB, was significantly associated with neonatal morbidity (adjusted odds ratio 4.00, 95% confidence interval 1.34–12.5), but not with maternal morbidity (adjusted odds ratio 1.23, 95% confidence interval 0.30–4.38).ConclusionsVaginal delivery, a favorable cervix after 24 h, the time from device insertion to delivery, and maternal morbidity did not significantly differ between the CRB and the dinoprostone vaginal insert for cervical ripening in obese women at term. Nevertheless, neonatal morbidity was significantly associated with the dinoprostone vaginal insert, compared with the CRB, among obese women who required cervical ripening at term.

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Effectiveness and adverse effects of vaginal misoprostol as a single agent for second trimester pregnancy termination: the impact of fetal viability

Pongsatha

Suntornlimsiri

Tongsong

2023

Arch Gynecol Obstet

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To compare the effectiveness of vaginal misoprostol for second trimester termination between pregnancies with a dead fetus in utero and those with a live fetus and to identify factors associated with the success rate. MethodsSingleton pregnancies with live fetuses and dead fetuses, between 14 and 28 weeks, with unfavorable cervix were recruited to have pregnancy termination with intravaginal misoprostol 400 mcg every 6 hours. ResultsMisoprostol was highly effective for termination, with a low failure rate of 6.3%. The effectiveness was signi cantly higher in pregnancies with a dead fetus (log-rank test; p: 0.008), with median delivery time of 11.2 vs 16.7 hours. Fetal viability, fetal weight or gestational age and an initial Bishop score were signi cantly related with total amount of misoprostol dosage used for induction. Fetal viability and gestational age / fetal weight were still an independent factor after adjustment on multivariate analysis. ConclusionVaginal misoprostol is highly effective for second trimester termination, with signi cantly higher effectiveness in pregnancies with a dead fetus. Also, the effectiveness is signi cantly associated with birth weight / gestational age, and initial Bishop score, suggesting that the regimen of misoprostol should be modi ed, depending on fetal viability and gestational age. Take Home MessageEffectiveness of is vaginal misoprostol signi cantly associated with fetal viability, birth weight / gestational age, and initial Bishop score, suggesting that the regimen of misoprostol should be modi ed, depending on fetal viability and gestational age.

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A comparison of cervical ripening modalities among overweight and obese nulliparous gravidas

Cited by 8 publications

References 16 publications

Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials

Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials

Cervical ripening balloon compared with vaginal dinoprostone for cervical ripening in obese women at term: A prospective cohort study

Effectiveness and adverse effects of vaginal misoprostol as a single agent for second trimester pregnancy termination: the impact of fetal viability

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