Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study

Beckwith, Lindsay; Magner, Kristin; Kritzer, Sara; Warshak, Carri R.

doi:10.1080/14767058.2016.1220523

Cited by 24 publications

(33 citation statements)

References 31 publications

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“…An additional 49 studies were excluded for the following reasons: not focused on induction of labor (n = 27), BMI not stratified (n = 12), no details for induction of labor protocol (n = 7), included only nulliparous women (n = 2), used nonstandard BMI categorizations (n = 1). Ten studies remained for the analysis …”

Section: Resultsmentioning

confidence: 99%

“…Eight of the 10 studies reporting outcomes of cesarean births were included in the meta‐analysis (n = 5450 participants). Five of the included studies were conducted in the United States; the remaining studies were carried out in Israel, Ireland, France, and Canada (Table ). The studies included in this review scored between 7 and 9 stars on the Newcastle‐Ottawa scale, indicating high quality .…”

Section: Resultsmentioning

confidence: 99%

“…The timing of BMI measurement differed between studies (Table ), including prepregnancy, the first prenatal visit, prenatal enrollment in the first trimester, perinatal enrollment before 25 weeks’ gestation, and the time of labor admission . Beckwith et al were the only investigators who analyzed outcomes using both the prepregnancy BMI and the time of hospital admission BMI with the rationale that a difference in effect could be due to a difference in volume distribution at the time of hospital admission. In addition, obesity was defined differently in several of the included studies (Tables , , and ).…”

Section: Resultsmentioning

confidence: 99%

“…In addition, obesity was defined differently in several of the included studies (Tables , , and ). Most of the studies used standard BMI categories defined by the Institute of Medicine or the World Health Organization, but 3 studies included only obese and nonobese categories, using a BMI of 30 kg/m 2 to separate the categories. In one of the included studies, the normal and overweight BMI categories were described but used differently in the analysis …”

Section: Resultsmentioning

confidence: 99%

“…Two different doses were reported by the investigators of studies involving dinoprostone (Cervidil: 3 mg or 10 mg vaginally), and both dose and route varied for studies involving misoprostol (Cytotec; 25‐100 mcg administered orally or vaginally). Among studies reporting results of labor inductions involving transcervical catheters, both involved Foley catheters, with one comparing Cook catheters with Foley catheters . We identified no studies that included a combination of prostaglandins and transcervical catheters.…”

Section: Resultsmentioning

confidence: 99%

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Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta‐Analysis

Ellis¹,

Brown²,

Barger³

et al. 2019

J Midwife Womens Health

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Introduction: Studies have shown that women with obesity have longer labors. The purpose of this systematic review and meta-analysis is to examine existing evidence regarding labor induction in women with obesity, including processes and outcomes. The primary outcome was cesarean birth following labor induction. Secondary outcomes were the timing and dosage of prostaglandins, the success of mechanical cervical ripening methods, and synthetic oxytocin dose and timing. Methods: Searches were performed in PubMed MEDLINE, Embase, CINAHL, EBSCO, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Effects, Google Scholar, and ClinicalTrials.gov. Searches were limited to studies published in English after 1990. Ten studies published between 2009 and 2017 were included in this review. All were observational studies comparing processes and outcomes of induction of labor in relation to maternal body mass index. The primary outcome was cesarean birth following labor induction. We assessed heterogeneity using Cochran’s Q test and tau-squared and I2 statistics. We also calculated fixed-effect models to estimate pooled relative risks and weighted mean differences. Results: Ten cohort studies met inclusion criteria; 8 studies had data available for a meta-analysis of the primary outcome. Cesarean birth was more common among women with obesity compared with women of normal weight following labor induction (Mantel-Haenszel fixed-effect odds ratio, 1.82; 95% CI, 1.55–2.12; P < .001). Maternal obesity was associated with a longer time to birth, higher doses of prostaglandins, less frequent success of cervical ripening methods, and higher dose of synthetic oxytocin, as well as a longer time to birth after oxytocin use. Discussion: Women with obesity are more likely than women with a normal weight to end labor induction with cesarean birth. Additionally, women with obesity require longer labor inductions involving larger, more frequent applications of both cervical ripening methods and synthetic oxytocin.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta‐Analysis

Ellis¹,

Brown²,

Barger³

et al. 2019

J Midwife Womens Health

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Vaginal Misoprostol Pharmacokinetic Changes in Obese Parturient Women Who Presented Labor Induction Failure

Filgueira,

Benzi,

Rodrigues

et al. 2024

The Journal of Clinical Pharma

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Clinical experience shows an increased duration of labor in obese parturient women. It is unclear if this population should receive the same dose of vaginal misoprostol for induction of labor as non‐obese parturient women. We investigate the influence of obesity on the pharmacokinetics and placental transfer of the metabolite misoprostol acid in parturient women. Parturient women (n = 40) were enrolled and received misoprostol 25 µg/6 h vaginally and were allocated into two groups according to the pre‐pregnancy body mass index (BMI <30 kg/m2 non‐obese, n = 18 or BMI >30 kg/m2 obese, n = 22) or according to the labor induction outcome (failure [n = 10] or success [n = 30]). Blood collection for pharmacokinetic study occurred after the first misoprostol dose. The pharmacokinetic parameters obtained in non‐obese parturient women were not statistically different from those obtained in obese group (P Value > .05). However, when the parturient women were grouped by the labor induction outcome, the failed labor induction group presented a higher (median [interquartile range]) BMI (44.4 [34.6‐47.9] vs 33.7 [28.9‐36.5] kg/m2) (P Value = .0017), lower Cmax (11.5 [4.82‐22.2] vs 22.8 [14.2‐30.8] pg/mL) (P Value = .0308) and not statistically different AUC0‐6 (31.8 [13.4‐61.5] vs 53.4 [35.4‐77.7]) pg·h/mL) (P Value = .0580) and tmax (2.50 [1.19‐4.25] vs 3.00 (1.88‐5.00) h (P Value = .3198) when compared with parturient women who presented successful labor induction. This data suggests a higher loading dose (higher volume of distribution) and unchanged maintenance dose (unchanged AUC0‐6) of misoprostol for this population. Further studies are required to investigate the efficacy and safety of higher misoprostol loading doses for this population.

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Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?

Hiersch

Borovich

Gabbay‐Benziv

et al. 2016

Arch Gynecol Obstet

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Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study

Abstract: Obese women receiving the same dose of misoprostol as non-obese women have higher rates of failure to achieve active labor, an effect not seen with mechanical ripening.

Cited by 24 publications

References 31 publications

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta‐Analysis

Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta‐Analysis

Vaginal Misoprostol Pharmacokinetic Changes in Obese Parturient Women Who Presented Labor Induction Failure

Can we predict successful cervical ripening with prostaglandin E2 vaginal inserts?

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