Induction of labor in the obese patient

Ruhstaller, Kelly

doi:10.1053/j.semperi.2015.07.003

Cited by 23 publications

(21 citation statements)

References 25 publications

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“…The induction method may also be a limitation of our study, as it was left to the discretion of each practitioner in each center. However, as our study and the literature show, there does not seem to be any induction method that is more common than another in the obese patient. Finally, there may be a lack of statistical power to detect significant associations, particularly in subgroup analyses.…”

Section: Discussionmentioning

confidence: 46%

Risk factors for failed induction of labor among pregnant women with Class III obesity

Kerbage

Senat

Drumez

et al. 2020

Acta Obstet Gynecol Scand

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| INTRODUC TI ONObesity and overweight are currently a public health problem in France. The World Health Organization has described obesity according to three increasing classes of severity as a function of body mass index (BMI), Class I (30-34.9 kg/m 2 ), Class II (35-39.9 kg/m 2 ) and Class III (≥40 kg/m 2 ). This description is correlated with the numbers and severity of complications observed in these populations. The specific and nonspecific complications of obesity are numerous. Cardiovascular complications are those responsible for the highest morbidity. 1 In obstetrics, obesity leads to the risk of complications (preeclampsia, gestational diabetes, pregnancy-induced Abstract Introduction: Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. Material and methods: This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m 2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. Results: In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. Conclusions: In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score. K E Y W O R D S cesarean delivery, induction of labor, morbid obesity, obesity, pregnancy, vaginal delivery

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Section: Discussionmentioning

confidence: 46%

Risk factors for failed induction of labor among pregnant women with Class III obesity

Kerbage

Senat

Drumez

et al. 2020

Acta Obstet Gynecol Scand

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“…In the future it could be interesting to evaluate if the effectiveness of misoprostol to reduce the rate of cesarean deliveries is the same in a population of women with BMI >30 kg/m 2 . Cesarean section is technically more difficult in these women and involves a higher rate of complications (infection, hemorrhage, wound complications, thromboembolism); moreover, obese women have an increased rate of failure of induction, which might be effectively targeted by the use of the misoprostol insert.…”

Section: Discussionmentioning

confidence: 99%

Labor induction with misoprostol vaginal insert compared with dinoprostone vaginal insert

Maggi

Mazzoni

Gerosa

et al. 2019

Acta Obstet Gynecol Scand

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Introduction Misoprostol vaginal insert could lead to a significant reduction in the time to vaginal delivery, and an increase in the proportion of women achieving vaginal delivery, compared with dinoprostone vaginal insert. We compared the delivery outcomes of misoprostol 200 μg vaginal insert and dinoprostone 10 mg vaginal insert for induction of labor in women with an unfavorable cervix. Material and methods This is a retrospective observational study conducted on a cohort of 220 women with a Bishop score ≤4 admitted for induction of labor at a single institution. Of these, 109 (49.5%) received the misoprostol vaginal insert and 111 (50.5%) received the dinoprostone vaginal insert. The primary outcome was the vaginal delivery rate. Secondary outcomes were time from induction to vaginal delivery, time to any delivery mode, time from induction to the onset of active labor, oxytocin use, uterine tachysystole and need for tocolysis. Results The vaginal delivery rate was 88% in the misoprostol insert group, compared with 74% in the dinoprostone insert group (P < 0.007). The average time from drug administration to the beginning of labor was shorter in the misoprostol compared with the dinoprostone group (855 min vs 1740 min, P < 0.0001). Also, the average time from administration to delivery was shorter for women receiving misoprostol compared with dinoprostone (1113 min vs 2150 min, P < 0.0001). The use of misoprostol reduced the need for oxytocin compared with dinoprostone (30.2% vs 43.2%, P = 0.046). Finally, compared with dinoprostone, the misoprostol insert was associated with more uterine tachysystole (38% vs 12%, P < 0.001), but the rate of tachysystole requiring tocolysis was not significantly different between the 2 groups (51.2% vs 46.1%, P = 0.1). Multivariate analysis showed that Bishop score and method of induction, but not maternal body mass index or gestational age at induction, were independently associated with mode of delivery. Conclusions The cesarean section rate was significantly lower in the misoprostol insert group. The use of misoprostol was also associated with reduced time to vaginal delivery and time to onset of active labor and with decreased use of oxytocin. Tachysystole was a frequent complication during induction of labor with the misoprostol insert.

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“…Limited studies explore the relationship between maternal obesity, BS and risk of failed IOL. It is known that obesity leads to a more difficult IOL process and higher CS rates . Currently, Australian guidelines exist for managing obesity in pregnancy but there stand no recommendations for the counselling of obese women prior to IOL .…”

Section: Discussionmentioning

confidence: 99%

“…It should also be noted that BS is a subjective measure and body habitus may affect the ability of the examiner to adequately perform or obtain a true BS, and this may result in a low BS in this cohort. Current evidence suggests that differences exist in myometrial composition between weight classes, with less contractility seen in the obese population . These physiological differences may also influence the cervical response to labour and therefore BS.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of maternal obesity on Bishop Score and failed induction of labour: A retrospective cohort study in a regional tertiary centre

Little

Nugent

Vangaveti

2018

Aust NZ J Obst Gynaeco

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Induction of labor in the obese patient

Cited by 23 publications

References 25 publications

Risk factors for failed induction of labor among pregnant women with Class III obesity

Risk factors for failed induction of labor among pregnant women with Class III obesity

Labor induction with misoprostol vaginal insert compared with dinoprostone vaginal insert

Influence of maternal obesity on Bishop Score and failed induction of labour: A retrospective cohort study in a regional tertiary centre

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