The effect of the MFM obesity protocol on cesarean delivery rates

Schuster, Meike; Madueke-Laveaux, Obianuju Sandra; Mackeen, A. Dhanya; Feng, Wen-Han; Paglia, Michael J.

doi:10.1016/j.ajog.2016.05.005

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Unlike our study, Schuster et al’s clinical protocol was associated with a slight increase in NICU admission, although these findings were not specific to obese women (24). This clinical protocol was tested in a single healthcare system, and analysis was limited to proxy indicators of neonatal morbidity (e.g., NICU admission) (24). In a hospital-based retrospective cohort study, Wolfe et al found that elective labor induction at 39 or 40 weeks, as compared to expectant management ≥39 weeks, was associated with increased risk of cesarean delivery and NICU admission among obese nulliparous patients with an unfavorable cervix (16).…”

Section: Discussioncontrasting

confidence: 99%

“…Similarly to our study, Schuster et al reported that a clinical protocol to induce obese women by their estimated due date reduced the rate of cesarean delivery, as compared to rates of cesarean delivery before the protocol was initiated (24). Unlike our study, Schuster et al’s clinical protocol was associated with a slight increase in NICU admission, although these findings were not specific to obese women (24). This clinical protocol was tested in a single healthcare system, and analysis was limited to proxy indicators of neonatal morbidity (e.g., NICU admission) (24).…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Pickens

Kramer

Howards

et al. 2018

Obstetrics &Amp; Gynecology

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 83%

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Pickens

Kramer

Howards

et al. 2018

Obstetrics &Amp; Gynecology

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“…Our data differ somewhat from those of Schuster et al , who examined 5,000 randomly selected women and showed a decrease in cesarean rate after implementation of a policy that included beginning delivery for patients with class III obesity by their estimated due date. That analysis did not stratify results by parity.…”

Section: Discussioncontrasting

confidence: 99%

“…Our data differ somewhat from those of Schuster et al (14), who examined 5,000 randomly selected women and showed a decrease in cesarean rate after implementation of a policy that included beginning delivery for patients with class III obesity by their estimated (15). A potentially important difference between our study and these two analyses is that our study included only women with class III obesity, whereas both the Schuster and the Gibbs Pickens analyses also included women with class I and II obesity.…”

Section: Discussioncontrasting

confidence: 92%

Impact of a Policy to Deliver at 39 Weeks for the Indication of Class III Obesity

Pierce

Maxted

Peck

et al. 2020

Obesity

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Objective The aim of this study was to evaluate the effect of a policy to deliver at 39 weeks for class III obesity. Methods This was a retrospective cohort study of women with class III obesity delivering at ≥ 37 weeks before (May 2012 to April 2014) and after the policy (September 2014 to August 2016). The primary outcome was the cesarean rate. Secondary outcomes included maternal morbidities and a neonatal morbidity composite. Modified Poisson regression was used to adjust for demographic differences between groups. Results The study included a total of 1,210 patients, 580 before the policy and 630 after the policy. Before and after the policy, cesarean rates were similar (41.6% vs. 47.1%; risk ratio [RR]: 1.13 [95% CI: 1.00‐1.29]; adjusted RR [aRR]: 1.03 [95% CI: 0.92‐1.14]). In adjusted comparisons of women undergoing labor induction, parous women had lower cesarean rates (aRR: 0.62; 95% CI: 0.41‐0.94) but nulliparous women had higher cesarean rates (aRR: 1.32; 95% CI: 1.04‐1.68) after the policy (P for interaction = 0.01). Rates of chorioamnionitis, endometritis, and cesarean wound infection were not different between groups. Composite neonatal morbidity was not different between pre‐ and postpolicy groups. Conclusions A policy of delivery at 39 weeks for class III obesity did not affect overall cesarean rate or rates of maternal or neonatal morbidity. Further investigation should evaluate subsets of women who may have a higher cesarean rate with this policy.

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“…5 Various approaches aimed to decrease cesarean delivery rates have been implemented, with differing degrees of success. [6][7][8][9][10][11] Fetal macrosomia, its management, and sequelae are constants in obstetric practice, as recently reviewed succinctly by Campbell 12 ; estimated fetal weight (EFW) is imprecise, 13 and overestimation of fetal size may lead to stronger tendency to opt for cesarean delivery for labor arrest. 14 It is the fetal head, however, that is the point of interface between the "passenger" and the "passageway."…”

Section: Introductionmentioning

confidence: 99%

Sonographic large fetal head circumference and risk of cesarean delivery

Lipschuetz

Cohen

Israel

et al. 2018

American Journal of Obstetrics and Gynecology

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Sonographic fetal head circumference ≥35 cm, measured within 1 week of delivery, is an independent risk factor for unplanned cesarean delivery but not instrumental delivery. Both fetal head circumference ≥35 cm and estimated fetal weight ≥3900 g significantly increased the risk of a prolonged second stage of labor. Fetal head circumference measurement in the last days before delivery may be an important adjunct to estimated fetal weight in labor management.

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The effect of the MFM obesity protocol on cesarean delivery rates

Cited by 10 publications

References 13 publications

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Impact of a Policy to Deliver at 39 Weeks for the Indication of Class III Obesity

Sonographic large fetal head circumference and risk of cesarean delivery

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