Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery without Labor

Yossi Bart; Rachel L. Wiley; Ipsita Ghose; Michal Fishel Bartal; Khalil M. Chahine; Suneet P. Chauhan; Sean Blackwell; Baha M. Sibai

doi:10.1055/a-2407-1857

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(04): 520-525
DOI: 10.1055/a-2407-1857

Original Article

Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery without Labor

Authors

Yossi Bart

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Rachel L. Wiley

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Ipsita Ghose

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Michal Fishel Bartal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas

²Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
Khalil M. Chahine

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Suneet P. Chauhan

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Sean Blackwell

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
Baha M. Sibai

¹Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas

Abstract

Objective This study aimed to compare maternal and neonatal outcomes between labor induction versus cesarean delivery (CD) without labor among nulliparous individuals with class III obesity (body mass index [BMI] ≥40 kg/m²).

Study Design A retrospective cohort study of all nulliparous singleton deliveries at ≥37 weeks with a BMI of ≥40 kg/m² at delivery between March 2020 and February 2022. We excluded individuals with spontaneous labor, fetal malformations, and stillbirths. The primary outcome was a composite of maternal mortality and morbidity, including infectious and hemorrhagic morbidity. The secondary outcome was a neonatal composite. A subgroup analysis evaluated patients with a BMI of ≥50 kg/m². Another subgroup analysis compared outcomes between CD without labor and an indicated CD following induction. A multivariable logistic regression was applied. For adjustment, we used possible confounders identified in a univariate analysis.

Results Among 8,623 consecutive deliveries during the study period, 308 (4%) met the inclusion criteria. Among them, 250 (81%) underwent labor induction, and 58 (19%) had a CD without labor. The most common indications for CD without labor were fetal malpresentation (26; 45%), suspected macrosomia (8; 14%), and previous myomectomy (5; 9%). Indicated CD occurred in 140 (56%) of the induced individuals, with the two leading indications being labor arrest (87; 62%) and non-reassuring fetal heart rate tracing (51; 36%). The rates of composite maternal morbidity (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 0.64–7.13) and composite neonatal morbidity (aOR = 3.62, 95% CI: 0.42–31.19) did not differ following a CD without labor compared to labor induction. The subgroup analyses did not demonstrate different outcomes between groups.

Conclusion Among nulliparous individuals with class III obesity at term who underwent induction, more than 50% had indicated CD; the rate of short-term maternal and neonatal morbidity, however, did not differ between labor induction and CD without labor.

Key Points

The rate of unplanned CD among those who underwent labor induction was relatively high (56.0%).
Outcomes did not differ between those who underwent CD without labor and those who were induced.
Outcomes also did not differ between those who underwent CD without labor and those with CD in labor.

Keywords

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

Full Text

References

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