title: Intrapartum management associated with obesity in nulliparous women.
abstract: BACKGROUND
  The objective of this systematic review was to determine the current state of knowledge about intrapartum management associated with obesity in healthy nulliparous women. Nulliparous obese women are at higher risk for unplanned cesarean birth when compared with their normal-weight counterparts, and much of this increased risk is associated with labor management differences. There is a need to better understand the differences in intrapartum management of nulliparous women who are obese.
  
  
  METHODS
  The PubMed, CINAHL, EBSCO, Google Scholar, and MEDLINE databases were searched in August 2012, with identified studies then assessed for applicability and quality. Eight studies were retained for the review.
  
  
  RESULTS
  Intrapartum interventions used significantly more often for healthy, obese nulliparous women when compared with normal-weight women were induction of labor, augmentation of labor, and cesarean birth. It is unclear if assisted vaginal birth occurs more frequently among obese women. Epidural anesthesia, artificial rupture of membranes prior to 6 cm of cervical dilation, and early hospital admission were shown in separate studies to be used more often in obese women. Intrapartum interventions were used more frequently in obese women in a dose-dependent manner by body mass index.
  
  
  CONCLUSIONS
  Future studies examining the intrapartum management of obese nulliparous women are needed with: 1) samples defined by standardized obesity classifications; 2) further analysis of diverse intrapartum interventions; and 3) prospective, randomized designs to allow for causality conclusions linking intrapartum intervention use to an obese woman's risk for cesarean birth. Implications for clinical practice from this systematic review are that healthy, nulliparous obese women are exposed to common intrapartum interventions more often than normal-weight women. In the absence of evidence on the use of appropriate use of intrapartum interventions in this population, health care providers should carefully monitor management choices when working with healthy, nulliparous obese women.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Carlson
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Lowe
mesh_terms: D015992:Body Mass Index; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007751:Labor, Induced; D007743:Labor, Obstetric; D009765:Obesity / Q000150:complications*; D009774:Obstetrics / Q000379:methods*; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications
keywords: cesarean birth; intervention; intrapartum; labor augmentation; labor dystocia; labor induction; maternal obesity