Abstract
Objective To assess the costs, complication rates, and harm-benefit tradeoffs of induction
of labor (IOL) compared to scheduled cesarean delivery (CD) in women with class III
obesity.
Study Design We conducted a cost analysis of IOL versus scheduled CD in nulliparous morbidly obese
women. Primary outcomes were surgical site infection (SSI), chorioamnionitis, venous
thromboembolism, blood transfusion, and readmission. Model outcomes were mean cost
of each strategy, cost per complication avoided, and complication tradeoffs. We assessed
the costs, complication rates, and harm-benefit tradeoffs of IOL compared with scheduled
CD in women with class III obesity.
Results A total of 110 patients underwent scheduled CD and 114 underwent IOL, of whom 61
(54%) delivered via cesarean. The group delivering vaginally experienced fewer complications.
SSI occurred in 0% in the vaginal delivery group, 13% following scheduled cesarean,
and 16% following induction then cesarean. In the decision model, the mean cost of
induction was $13,349 compared with $14,575 for scheduled CD. Scheduled CD costs $9,699
per case of chorioamnionitis avoided, resulted in 18 cases of chorioamnionitis avoided
per additional SSI and 3 cases of chorioamnionitis avoided per additional hospital
readmission. In sensitivity analysis, IOL is cost saving compared with scheduled CD
unless the cesarean rate following induction exceeds 70%.
Conclusion In morbidly obese women, induction of labor remains cost-saving until the rate of
cesarean following induction exceeds 70%.
Keywords
obesity - pregnancy - cesarean - surgical site infection - cost-effectiveness - induction
of labor
