Intrapartum Management Associated with Obesity in Nulliparous Women

Carlson, Nicole S.; Lowe, Nancy K.

doi:10.1111/jmwh.12073

Cited by 28 publications

(44 citation statements)

References 69 publications

(231 reference statements)

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“…Finally, our study was limited by the distribution of BMI in the final sample, with the majority of subjects (62.5%) having BMIs between 30 and 34.99 kg/m 2 . BMI effects on labor performance and oxytocin response are known to be dose dependent (Carlson & Lowe, 2014; Walsh et al, 2011). Therefore, the clustering of our sample around low levels of maternal obesity limits our conclusions.…”

Section: Discussionmentioning

confidence: 99%

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Carlson

Corwin

Lowe

2017

Biological Research For Nursing

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Background Synthetic oxytocin, the primary tool for labor augmentation, is less effective among obese women, leading to more unplanned cesarean deliveries for slow labor progress. It is not known if obese women require higher doses of oxytocin due to maternal, fetal, or labor factors related to maternal obesity. Objectives This study had two main objectives: 1) Examine the influence of maternal body mass index (BMI) on hourly doses of oxytocin from augmentation initiation until vaginal delivery in obese women; and 2) Examine the influence of other maternal, fetal, and labor factors on hourly doses of oxytocin in obese women. Study design Longitudinal study of a cohort (N = 136) of healthy, nulliparous, spontaneously laboring obese women (BMI ≥ 30 kg/m2) who received oxytocin augmentation and achieved vaginal delivery. We performed iterative multilevel analyses to examine the influence of maternal BMI and other factors on hourly oxytocin doses. Results Maternal BMI explained 16.56% (95% CI [13.7-20.04], p < 0.001) of the variance in hourly oxytocin doses received in a multilevel model controlling for influence of maternal, fetal, and labor characteristics. Maternal age, gestational age, status of amniotic membranes at hospital admission, and admission cervical dilation examination were not significant; however, neonatal birthweight and cervical dilation at oxytocin initiation were significant predictors of hourly oxytocin dose in these women (p < 0.001). Conclusions Even when parturition preparation has progressed adequately for spontaneous labor initiation, there still may be some obesity-related blunting of myometrial contractility and response to oxytocin used for augmentation.

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Section: Discussionmentioning

confidence: 99%

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Carlson

Corwin

Lowe

2017

Biological Research For Nursing

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“…A systematic review of eight studies 149 Establishing venous access in women with class III obesity is more likely to be difficult than in women with class I and II obesity. It is important that this is not attempted for the first time in an emergency situation when urgent venous access is required for intravenous medication or for resuscitation.…”

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confidence: 99%

Care of Women with Obesity in Pregnancy

Denison¹,

Aedla²,

Keag³

et al. 2018

BJOG

184

187

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“…[1][2][3] Currently, 27.1% of women in the United States are obese prior to pregnancy, and in non-Hispanic black women, the prevalence of obesity is even higher, approaching 40%. 4 Women with obesity receive more medical interventions during their labors, 5 have slower labors, 6,7 and have a higher risk of cesarean birth, with rates up to 5 times higher than rates of women with a normal body mass index (BMI). 8,9 Safe prevention of cesarean birth in women with a high BMI is especially important, as this population is also at increased risk of morbidity and mortality following cesarean birth.…”

Section: Introductionmentioning

confidence: 99%

Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

Carlson

Breman

Neal

et al. 2019

J Midwife Womens Health

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Introduction: Maternal obesity is associated with slow labor progression and unplanned cesarean birth. Midwives use fewer medical interventions during labor, and the women they care for have lower cesarean birth rates, compared with low-risk, matched groups of women cared for by physicians. The primary aim of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Unit-level presence of midwives was analyzed as a representation of a unique set of care practices that exist in settings where midwives work. Methods: A retrospective cohort study was conducted using Consortium on Safe Labor data from low-risk, healthy women who labored and gave birth in medical centers with (n = 9795) or without (n = 13,398) the unit-level presence of midwives. Regression models were used to evaluate for associations between unit-level midwifery presence and 1) the incidence of unplanned cesarean birth and 2) in-hospital labor durations with stratification by maternal BMI and adjustment for maternal demographic and pregnancy factors. Results: The odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women at who gave birth at centers without midwives (adjusted odds ratio, 0.84; 95% CI, 0.77-0.93). However, women whose BMI was above 35.00 kg/m 2 at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. In-hospital labor duration prior to unplanned cesarean was no different by unit-level midwifery presence in nulliparous women whose BMI was above 35.00 kg/m 2. Discussion: Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.

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Intrapartum Management Associated with Obesity in Nulliparous Women

Cited by 28 publications

References 69 publications

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Oxytocin Augmentation in Spontaneously Laboring, Nulliparous Women: Multilevel Assessment of Maternal BMI and Oxytocin Dose

Care of Women with Obesity in Pregnancy

Preventing Cesarean Birth in Women with Obesity: Influence of Unit‐Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set

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