Maternal obesity and labour complications following induction of labour in prolonged pregnancy.
OBJECTIVE
To investigate the effect of maternal obesity on mode of delivery following induction of labour (IOL) for prolonged pregnancy and subsequent intrapartum and neonatal complications.


METHODS
Retrospective (historical) cohort study.


METHODS
Liverpool Women's Hospital NHS Foundation Trust, UK.


METHODS
A total of 29, 224 women with singleton pregnancies between 2004 and 2008 of whom 3076 had a prolonged pregnancy (defined as ≥290 days or 41(+3) weeks of gestation) and received IOL.


METHODS
Kruskal-Wallis test, chi-square test and multivariable logistic regression.


METHODS
Mode of delivery and risk of delivery and neonatal complications in obese verses non-obese women following IOL.


RESULTS
Obese women had a significantly higher rate of IOL ending in caesarean section compared with women of normal weight following IOL (38.7% versus 23.8% primiparous; 9.9% versus 7.9% multiparous women, respectively); however, length of labour, incidence of postpartum haemorrhage and third-degree tear, rate of low cord blood pH, low Apgar scores and shoulder dystocia were similar in all body mass index categories. Complications included a higher incidence of fetal macrosomia and second-degree, but not third-degree, tear in primiparous women.


CONCLUSIONS
Higher maternal body mass index at booking is associated with an increased risk of prolonged pregnancy and increased rate of IOL. Despite this, more than 60% of obese primiparous and 90% of multiparous women with prolonged pregnancies who were induced achieved vaginal delivery and labour complications in the obese women with prolonged pregnancies were largely comparable to those of normal weight women with prolonged pregnancies. Our data suggest that IOL for prolonged pregnancy in obese women is a reasonable and safe management option.
Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, UK. s.arrowsmith@liv.ac.uk
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Arrowsmith
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Wray
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Quenby
D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007751:Labor, Induced; D009765:Obesity / Q000150:complications*; D007744:Obstetric Labor Complications / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011273:Pregnancy, Prolonged / Q000628:therapy*; D012189:Retrospective Studies
BJOG. 2005 Jun;112(6):768-72
15924535
J Midwifery Womens Health. 2006 Jul-Aug;51(4):254-259
16814219
BJOG. 2007 Mar;114(3):343-8
17261121
BMJ. 2006 Dec 2;333(7579):1159-62
17138998
Am J Public Health. 2007 Jan;97(1):157-62
17138924
Arch Gynecol Obstet. 2008 Jul;278(1):23-6
18071728
Am J Obstet Gynecol. 2007 Oct;197(4):378.e1-5
17904967
Am J Obstet Gynecol. 2003 Jul;189(1):222-7
12861166
Obstet Gynecol Surv. 2008 Nov;63(11):715-24
18928576
Int J Obes (Lond). 2010 Mar;34(3):420-8
20029373
Obstet Gynecol. 2004 Feb;103(2):219-24
14754687
Obstet Gynecol. 2004 Nov;104(5 Pt 1):943-51
15516383
BJOG. 2008 May;115(6):720-5
18410655
Am J Obstet Gynecol. 1992 Aug;167(2):353-70; discussion 370-2
1497038
Am J Obstet Gynecol. 2007 Feb;196(2):155.e1-6
17306661
BMC Public Health. 2007 Jul 24;7:168
17650297
Am J Obstet Gynecol. 2006 Sep;195(3):700-5
16949399
Obstet Gynecol. 2005 Aug;106(2):250-9
16055572
Int J Obes Relat Metab Disord. 2001 Aug;25(8):1175-82
11477502
Obes Rev. 2008 Nov;9(6):635-83
18673307
BJOG. 2005 Oct;112(10):1431-3
16167951
Eur J Epidemiol. 2009;24(11):697-705
19653107
BMJ. 1988 Aug 20-27;297(6647):515-7
3139180
Am J Obstet Gynecol. 2009 Jun;200(6):683.e1-5
19380120