title: Obesity as a risk factor for failed trial of labor in patients with previous cesarean delivery.
abstract: OBJECTIVE
  This study was undertaken to determine whether obesity is a risk factor for failed trial of labor (TOL) in women with previous cesarean delivery (CD).
  
  
  METHODS
  We performed a review of singleton gestations 36 weeks or greater with previous CD who underwent TOL from January 1998 to June 2002, stratifying by body mass index (BMI, kg/m2): normal (BMI <25), overweight (BMI 25-29.9), obese (BMI 30-39.9), and morbidly obese (BMI >40). Rates for failed TOL were determined, and groups compared.
  
  
  RESULTS
  For 725 patients, failed TOL rates were as follows: 14.1%, 20.4%, 27.7%, and 30.3% for normal, overweight, obese, and morbidly obese groups, respectively (P < .0001). Significant risk factors included: no previous vaginal delivery, labor induction, recurrent CD indication, and fetal macrosomia. However, obesity remained an independent risk factor for failed TOL in the obese and morbidly obese groups with odds ratio of 1.99 (95% CI 1.20-3.30) and 2.22 (1.11-4.44) for these groups (P = .03), respectively.
  
  
  CONCLUSIONS
  Obesity is an independent risk factor for failed TOL in patients with previous CD.
authors.affiliation: Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, The University of Chicago, Chicago, Ill, USA. pgoodall@babies.bsd.uchicago.edu
authors.forename: Perpetua T
authors.initials: PT
authors.lastname: Goodall
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Ahn
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Chapa
authors.forename: Judith U
authors.initials: JU
authors.lastname: Hibbard
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D002585:Cesarean Section; D016001:Confidence Intervals; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D007751:Labor, Induced; D009765:Obesity / Q000473:pathology / Q000503:physiopathology*; D009767:Obesity, Morbid / Q000473:pathology / Q000503:physiopathology; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor