title: Induction of labor with an unfavorable cervix: how does BMI affect success? (‡).
abstract: OBJECTIVE
  Obesity places women and their babies at risk for obstetric and perinatal morbidity including induction of labor and cesarean delivery. We sought to evaluate the impact of body mass index (BMI) on successful induction of labor using misoprostol at our institution. The primary outcome was time to delivery. Secondary outcomes were number of doses of misoprostol, duration of oxytocin and cesarean delivery.
  
  
  METHODS
  A retrospective cohort over two years found 329 patients who were  > 37 weeks of gestational age and had a Bishop score  < 5 prior to beginning induction. Patients were divided into three categories based on their BMI: Group 1: BMI ≤ 30 kg/m(2), Group 2: BMI 30 to 39.9 kg/m(2) and Group 3: BMI ≥ 40 kg/m(2). Statistical analysis included the use of multivariate analysis, contingency tables and Chi-square tests for categorical data and Pearson's correlation coefficient for numerical data.
  
  
  RESULTS
  There were no significant differences among the groups when analyzed for gestational age, bishop score, median parity or race. Time to delivery increased significantly with increasing BMI (p < 0.01). Furthermore, women with higher BMIs required more doses of misoprostol (p < 0.01), longer duration of oxytocin administration prior to delivery (p < 0.02) and increased risk of cesarean section (p < 0.0006).
  
  
  CONCLUSIONS
  As BMI increases, obese patients undergoing induction with misoprostol have a longer time to delivery, require more doses of misoprostol, require a longer duration of oxytocin and have higher cesarean delivery rate.
authors.affiliation: a Department of Obstetrics and Gynecology , University of South Alabama, CWEB 1 , Mobile , AL , USA .
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Lassiter
authors.affiliation: a Department of Obstetrics and Gynecology , University of South Alabama, CWEB 1 , Mobile , AL , USA .
authors.forename: Nicolette
authors.initials: N
authors.lastname: Holliday
authors.affiliation: a Department of Obstetrics and Gynecology , University of South Alabama, CWEB 1 , Mobile , AL , USA .
authors.forename: David F
authors.initials: DF
authors.lastname: Lewis
authors.affiliation: b Department of Mathematics and Statistics University of South Alabama , CWEB 1 , Mobile , AL , USA , and.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Mulekar
authors.affiliation: c University of South Alabama , Mobile , AL , USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Abshire
authors.affiliation: a Department of Obstetrics and Gynecology , University of South Alabama, CWEB 1 , Mobile , AL , USA .
authors.forename: Brian
authors.initials: B
authors.lastname: Brocato
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D015992:Body Mass Index; D002584:Cervix Uteri; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000379:methods*; D007743:Labor, Obstetric / Q000187:drug effects; D016595:Misoprostol / Q000008:administration & dosage*; D015999:Multivariate Analysis; D009765:Obesity / Q000145:classification / Q000150:complications*; D007744:Obstetric Labor Complications / Q000209:etiology*; D010121:Oxytocin / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D010121:Oxytocin
keywords: BMI; Bishop score; cervical ripening; misoprostol; oxytocin