Risk of cesarean delivery among pregnant women with class <scp>III</scp> obesity

Borghesi, Yves; Labreuche, Julien; Duhamel, Alain; Pigeyre, Marie; Deruelle, Philippe

doi:10.1002/ijgo.12032

Cited by 12 publications

(13 citation statements)

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“…Two other induction failure factors were identified in the literature but were not significant in our population. First, the history of cesarean section appeared to be pejorative, most notably in the study by Borghesi et al The small sample size (16 patients) with a history of cesarean section made it difficult to interpret the results in our study. In fact, it is likely that a large number of patients had a cesarean section before labor and that the small remaining number delivered spontaneously.…”

Section: Discussionmentioning

confidence: 72%

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: 72%

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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“…Three studies, 7,14,15 reporting on 3625 pregnancies, compared outcomes in women planning a vaginal birth, based on the actual mode of birth (successful vaginal birth vs intrapartum CD) (Table 4, Figure 2C). The two groups were dissimilar, in that women requiring intrapartum CD were more likely to be nulliparous (69.5% vs 30.1%, P < .001), and more likely to have gestational diabetes (33.0% vs 20.0%, P = .03) and hypertensive disorders of pregnancy (13.3% vs 22.2%, P = .05).…”

Section: Resultsmentioning

confidence: 99%

“…For example, those that had a successful vaginal birth had a lower chance of PPH (15.1% vs 70.0%, RR 0.21 (0.19‐0.23), NNH = 2), wound infection/disruption (0% vs 4.4%, RR 0.05 (0.003‐0.88), NNH = 23), hospitalization >4 days (1.9% vs 6.7%, RR 0.28 (0.08‐0.98), NNH = 22) and five‐minute Apgar scores < 7 (1.0% vs 5.6%, RR 0.17 (0.03‐0.86), NNH = 21). Most outcomes were reported by one study only, 7 except for PPH (3 studies) 7,14,15 and birth trauma (2 studies) 7,14 …”

Section: Resultsmentioning

confidence: 99%

“…Of the 10 258 records obtained, 44 full texts were reviewed and 10 studies 7,[11][12][13][14][15][16][17][18][19] comparing labor and delivery outcomes in women with BMI ≥ 40 kg/m 2 based on planned or actual mode of birth were included in the final analysis ( Figure 1). Excluded studies with reasons for exclusion are listed in Appendix S3.…”

Section: General Characteristics Of Studiesmentioning

confidence: 99%

“…These pregnancies are also at risk for neonatal complications that could be, directly or indirectly, related to the labor and birth, such as birth trauma (1.26% vs 0.88%, RR 2.07), neonatal hypoglycemia (4.05% vs 1.38%, RR 3.27), early neonatal infection (2.75% vs 1.34%, RR 2.25), respiratory distress (5.08% vs 2.74%, RR 1.98), neonatal intensive care unit admissions (13.74% vs 9.51%, RR 1.63) and neonatal death (1.42% vs 0.93, RR 1.84) 2 . While it is generally accepted that a vaginal birth is preferred over a CD, the challenges with induction and surveillance of labor, and the high possibility of requiring a technically‐challenging unplanned CD, 6 and subsequently, sub‐optimal outcomes, 7 in women with BMI ≥ 40 kg/m 2 , raises the question on the optimal method of delivery in these women. Since evidence‐based knowledge is essential to inform clinical practice and counseling regarding the mode of delivery, the aim of this paper is to systematically review published data on labor and delivery outcomes in women with BMI ≥ 40 kg/m2 (Class‐III Obesity) based on planned and actual modes of birth.…”

Section: Introductionmentioning

confidence: 99%

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Birth outcomes in women with body mass index of 40 kg/m² or greater stratified by planned and actual mode of birth: a systematic review and meta‐analysis

D’Souza

Horyn²,

Jacob

et al. 2020

Acta Obstet Gynecol Scand

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Introduction Pregnant women with a body mass index (BMI) ≥40 kg/m2 are at an increased risk of requiring planned‐ and unplanned cesarean deliveries (CD). The aim of this systematic review is to compare outcomes in women with BMI ≥ 40 kg/m2 based on planned and actual mode of birth. Material and Methods Five databases were searched for English and French‐language publications until February 2019, and all studies reporting on delivery outcomes in women with BMI ≥ 40 kg/m2, stratified by planned and actual mode of birth, were included. Risk‐of‐bias was assessed using the Newcastle‐Ottawa Scale. Relative risks (RR) and 95% confidence intervals were calculated using random‐effects meta‐analysis. Results Ten observational studies were included. Anticipated vaginal birth vs planned CD (5 studies, n = 2216) was associated with higher risk for postpartum hemorrhage (13.0% vs 4.1%, P < .001, numbers needed to harm (NNH = 11), I2 = 0%) but lower risk for wound complications (7.6% vs 14.5%, P < .001, numbers needed to treat (NNT = 15), I2 = 58.3%). Planned trial of labor vs repeat CD (3 studies, n = 4144) was associated with higher risk for uterine dehiscence (0.94% vs 0.42%, P = .04, NNH = 200, I2 = 0%), endometritis (5.1% vs 2.2%, P < .001, NNH = 35, I2 = 0%), prolonged hospitalization (one study, 30.3% vs 26.0%, P = .003, NNH = 23), low five‐minute Apgar scores (4.9% vs 1.7%, RR 2.95 (2.03, 4.28), NNH = 30, I2 = 0%) and birth trauma (1.1% vs 0.2%, P < .001, NNH = 111, I2 = 0%). Successful vaginal birth vs intrapartum CD (n = 3625) was associated with lower risk of postpartum hemorrhage (15.1% vs 70%, P < .001, NNT = 2, I2 = 0%), wound complications (one study, 0% vs 4.4%, P = .007, NNT = 23), prolonged hospitalization (one study, 1.9% vs 6.7%, 0.04, NNT = 21) and low five‐minute Apgar scores (one study, 1.0% vs 5.6%, P = .03, NNT = 22), but more birth trauma (5.9% vs 0.6%, P = .005, NNH = 19, I2 = 0%). Compared groups had dissimilar demographic characteristics. Although studies scored 6‐7/9 on risk‐of‐bias assessment, they were at high‐risk for confounding by indication. Conclusions Evidence from observational studies suggests clinical equipoise regarding the optimal mode of delivery in women with BMI ≥ 40 kg/m2 and no prior CD. This question is best answered by a randomized trial. Based on an unplanned subgroup analysis, for women with BMI ≥ 40 kg/m2 and prior CD, repeat CD may be associated with better clinical outcomes.

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Prediction of intrapartum cesarean delivery among women with obesity: A retrospective cohort study

Gabbai,

Gilboa,

Attali

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo determine risk factors and design a clinically based predictive model for the risk of intrapartum cesarean delivery (CD) in women with obesity.MethodsA retrospective cohort study was conducted in a single tertiary medical center between 2012 and 2022 and included all consecutive women with a pre‐gestational body mass index (BMI) ≥30 who planned a trial of labor. Uni‐ and multivariate analyses compared maternal and neonatal characteristics of women who delivered vaginally to those who underwent intrapartum CD. A specific risk prediction score was developed in accordance with the relative risk to predict the need for intrapartum CD.ResultsOf the 5663 women with obesity included in the study cohort, 424 (7.5%) underwent intrapartum CD and 5239 (92.5%) delivered vaginally. The independent risk factors for CD were maternal age >35 years, pre‐gestational BMI category (BMI 35–40 and BMI >40), nulliparity, epidural anesthesia, induction of labor, antibiotic administration during labor, multiple gestation, previous uterine scar, and pre‐eclampsia. The intrapartum CD prediction score model demonstrated predictive performance with 85% sensitivity and 70% specificity.ConclusionScore model for intrapartum CD can be used by caregivers to offer a more informed consultation to women with obesity facing the decision of mode of delivery.

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Risk of cesarean delivery among pregnant women with class III obesity

Abstract: Nulliparous women with class III obesity attempting a vaginal delivery should be warned of the high risk of cesarean delivery, especially if they require induction.

Cited by 12 publications

References 24 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

Birth outcomes in women with body mass index of 40 kg/m² or greater stratified by planned and actual mode of birth: a systematic review and meta‐analysis

Prediction of intrapartum cesarean delivery among women with obesity: A retrospective cohort study

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Risk of cesarean delivery among pregnant women with class III obesity

Abstract: Nulliparous women with class III obesity attempting a vaginal delivery should be warned of the high risk of cesarean delivery, especially if they require induction.

Cited by 12 publications

References 24 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

Birth outcomes in women with body mass index of 40 kg/m2 or greater stratified by planned and actual mode of birth: a systematic review and meta‐analysis

Prediction of intrapartum cesarean delivery among women with obesity: A retrospective cohort study

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Birth outcomes in women with body mass index of 40 kg/m² or greater stratified by planned and actual mode of birth: a systematic review and meta‐analysis