title: Mode of delivery in women with class III obesity: planned cesarean compared with induction of labor.
abstract: OBJECTIVE
  To compare maternal and neonatal outcomes between planned cesarean delivery and induction of labor in women with class III obesity (body mass index ≥40 kg/m(2)).
  
  
  METHODS
  In this retrospective cohort study, we identified all women with a body mass index ≥40 kg/m(2) who delivered a singleton at our institution from January 2007 to February 2013 via planned cesarean or induction of labor (regardless of eventual delivery route) at 37-41 weeks. Patients in spontaneous labor were excluded. The primary outcome was a composite of maternal morbidity including death as well as operative, infection, and thromboembolic complications. The secondary outcome was a neonatal morbidity composite. Additional outcomes included individual components of the composites. Student t, χ(2), and Fisher exact tests were used for statistical analysis. To calculate adjusted odds ratios, covariates were analyzed via multivariable logistic regression.
  
  
  RESULTS
  There are 661 mother-infant pairs that met enrollment criteria-399 inductions and 262 cesareans. Groups were similar in terms of prepregnancy weight, pregnancy weight gain, and delivery body mass index. Of the 399 inductions, 258 had cervical ripening (64.7%) and 163 (40.9%) had a cesarean delivery. After multivariable adjustments, there was no significant difference in the maternal morbidity composite (adjusted odds ratio, 0.98; 95% confidence interval, 0.55-1.77) or in the neonatal morbidity composite (adjusted odds ratio, 0.81; 95% confidence interval, 0.37-1.77) between the induction and cesarean groups.
  
  
  CONCLUSIONS
  In term pregnant women with class III obesity, planned cesarean does not appear to reduce maternal and neonatal morbidity compared with induction of labor.
authors: Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: asubramaniam@uabmc.edu.
authors: Akila
authors: A
authors: Subramaniam
authors: Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: Victoria Chapman
authors: VC
authors: Jauk
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
authors: Amy Reed
authors: AR
authors: Goss
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.
authors: Mitchell Dean
authors: MD
authors: Alvarez
authors: Center for Women's Reproductive Health, and School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: Crystal
authors: C
authors: Reese
authors: Division of Maternal-Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors: Rodney Kirk
authors: RK
authors: Edwards
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D017604:Cesarean Section, Repeat / Q000379:methods; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D004716:Endometritis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D007751:Labor, Induced / Q000379:methods*; D008428:Maternal Mortality; D015999:Multivariate Analysis; D009767:Obesity, Morbid; D007744:Obstetric Labor Complications / Q000453:epidemiology; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
keywords: cesarean; class III obesity; induction of labor; mode of delivery