title: Risk of cesarean delivery among pregnant women with class III obesity.
abstract: OBJECTIVE
  To identify factors associated with cesarean delivery among women with class III obesity attempting vaginal delivery.
  
  
  METHODS
  In a retrospective study, medical charts were reviewed for women aged 18 years or older with a singleton pregnancy of at least 37 weeks and a body mass index (calculated as weight in kilograms divided by the square of height in meters) of 40 or higher who were eligible to attempt vaginal delivery at a maternity hospital in Lille, France, between 1999 and 2012.
  
  
  RESULTS
  Among 345 eligible women, 301 (87.2%) attempted vaginal delivery; 211 (70.1%) were successful and 90 (29.9%) delivered by cesarean. The frequency of nulliparity was higher among those undergoing cesarean after a trial of labor (64 [71.1%]) than among those who delivered vaginally (57 [27.0%]; P<0.001). Induction of labor was also more frequent among those who ultimately delivered by cesarean (61 [67.8%] vs 96 [45.5%]; P<0.001). In multivariate analysis, induction of labor was an independent predictor of cesarean among women attempting vaginal delivery (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.25-4.22), whereas history of vaginal delivery was protective (OR 0.08, 95% CI 0.04-0.17).
  
  
  CONCLUSIONS
  Nulliparous women with class III obesity attempting a vaginal delivery should be warned of the high risk of cesarean delivery, especially if they require induction.
authors.affiliation: Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Borghesi
authors.affiliation: Equipe d'Accueil 2694, Santé publique: épidémiologie et qualité des soins, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.affiliation: Equipe d'Accueil 2694, Santé publique: épidémiologie et qualité des soins, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Department of Nutrition, Centre Hospitalier Universitaire de Lille, Lille, France.|Unit 1190-European Genomic Institute of Diabetes, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Pigeyre
authors.affiliation: Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France.|Equipe d'Accueil EA 4489, Université de Lille, Environnement Périnatal et Santé, Lille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Deruelle
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006771:Hospitals, Maternity; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014219:Trial of Labor; D055815:Young Adult
keywords: Cesarean delivery; Labor; Obesity; Pregnancy; Vaginal delivery