Maternal Obesity Class as a Predictor of Induction Failure: A Practical Risk Assessment Tool

Stefania Ronzoni; Hadar Rosen; Nir Melamed; Shay Porat; Dan Farine; Cynthia Maxwell

doi:10.1055/s-0035-1563717

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2015; 32(14): 1298-1304
DOI: 10.1055/s-0035-1563717

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Obesity Class as a Predictor of Induction Failure: A Practical Risk Assessment Tool

Autor*innen

Stefania Ronzoni

¹Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Hadar Rosen

¹Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Nir Melamed

²Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
Shay Porat

³Department of Obstetrics and Gynecology, Hadassah-Hebrew, University Medical Center, Mt Scopus Campus, Jerusalem, Israel
Dan Farine

¹Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Cynthia Maxwell

¹Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada

Abstract

Objective To assess the impact of body mass index (BMI) on the rate of cesarean section (rCS) in induction of labor (IOL).

Study Design A total of 7,543 singleton term pregnancies undergoing IOL (cervical dilatation at admission, CDA ≤ 3 cm) were divided according to BMI: underweight (n = 325); normal weight (NW) (n = 4,633); overweight (OW) (n = 1,610); and obese (n = 975). Age, parity, macrosomia, gestational age (GA), gestational weight gain (GWG), CDA, and IOL indications were considered.

Results A higher rate of macrosomia (15.0 vs. 11.1%; p < 0.0001), earlier induction (GA 39.7 ± 1.3 vs. 40.1 ± 1.3 weeks; p < 0.0001) for maternal indications (39.1 vs. 21.1%; p < 0.001), and lower CDA (≤1cm; 66.4 vs. 61.4%; p < 0.005) were observed in obese versus NW. The rate of weight gain above the recommended range was higher in obese (obese 70.6% vs. NW 43.9%; p < 0.001), despite a significantly lower mean GWG compared with NW (14 ± 7.5 vs. 16.5 ± 5.6 kg; p < 0.001). Compared with NW, OW and obese demonstrated a significantly higher rCS (OW 31.1% and obese 36.9% vs. NW 24.7%; p < 0.001). BMI represented an independent factor affecting the rCS (vs. NW; OW odds ratio [OR] 1.4; confidence interval [CI] 1.2–1.7; p < 0.001; obese OR 2.3; CI 1.9–2.7 p < 0.001).

Conclusion In the case of IOL, obesity represents an independent factor associated with a significant increase of CS to be considered during induction counselling.

Keywords

body mass index - cesarean section - induction of labor - obesity

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Referenzen

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