title: Computational model for timing of delivery in an obese population.
abstract: OBJECTIVE
  To estimate the impact on stillbirth risk, cesarean deliveries, and delivery-related healthcare cost associated with induction of labor compared to expectant management of term pregnancies in an obese population.
  
  
  METHODS
  A decision analysis model was designed to compare the delivery and cost outcomes associated with a hypothetical cohort of 100,000 term pregnancies, complicated by obesity, that were planning a vaginal delivery. The model predicted stillbirths, cesarean deliveries, and total delivery-related health care cost from routine induction at 39 weeks compared to expectant management and routine induction each week from 40 to 42 weeks.
  
  
  RESULTS
  There were 387 stillbirths avoided by routine induction at 39 weeks compared to the worst-case model of expectant management with induction at 42 weeks. 9234 cesarean deliveries were avoided by routine induction at 39 weeks compared to the worst-case model of expectant management and induction at 41 weeks (30,888 vs. 40,122) . Routine induction at 39 weeks showed a savings in delivery-related health care cost of 30 million dollars compared to the worst-case model of expectant management and induction at 41 weeks (536 million vs. 566 million).
  
  
  CONCLUSIONS
  Utilizing this computational model, routine induction at 39 weeks minimizes stillbirths, cesarean deliveries, and delivery-related health care cost.
authors.affiliation: a Department of Obstetrics and Gynecology , University of Minnesota , Minneapolis , MN , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gill
authors.affiliation: b Department of Obstetrics and Gynecology , TriHealth , Cincinnati , OH , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Holbert
mesh_terms: D003661:Decision Support Techniques; D036861:Delivery, Obstetric / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000191:economics* / Q000706:statistics & numerical data; D009765:Obesity; D011247:Pregnancy; D011248:Pregnancy Complications; D011263:Pregnancy Trimester, Third; D050497:Stillbirth
keywords: Obesity; cesarean; delivery timing; stillbirth