Term Elective Induction of Labor and Risk of Cesarean Delivery in Obese Women [326]. (May 2015)

• Record Type: Journal Article
• Authors: Lee, Vanessa Rose; Snowden, Jonathan; Darney, Blair G.; Main, Elliott Kingwill; Gilbert, William M.; Caughey, Aaron B.
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000463635.44038.3e
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Current data are conflicting on whether elective induction of labor increases the rate of cesarean delivery in obese women. This study characterizes the risk of cesarean delivery in obese women undergoing term elective induction of labor compared with expectant management. METHODS: Retrospective cohort study of singleton, vertex, nonanomalous deliveries among obese women (body mass index [BMI, calculated as weight (kg)/[height (m)] 2 ] ≥ 30) in California in 2008 (N=63, 056). Women with a prior cesarean delivery, diabetes, or other chronic disease complicating pregnancy were excluded. We compared elective induction of labor at 38, 39, or 40 weeks of gestation with expectant management stratified by parity and World Health Organization obesity class. We used χ 2 statistics and multivariate logistic regression models controlling for maternal age, ethnicity, and socioeconomic status. RESULTS: The proportions of women undergoing cesarean delivery were not significantly different between elective induction of labor and expectant management groups among nulliparous women with a BMI of 30–35 or 35–39. In nulliparous women with a BMI of 40 or higher, elective induction of labor at 38 weeks of gestation was associated with lower odds of cesarean delivery. Multiparous women with a BMI of 30–35 had significantly lower odds of cesarean delivery with elective induction of labor across all gestational ages. Elective induction of labor was also associated with lower odds of cesarean delivery at 38 and 39 weeks of gestation among multiparous women with a BMI of 35–39. CONCLUSION: Elective induction of labor does not increase the odds of cesarean delivery compared with expectant management in nulliparous obese women. Furthermore, early term elective induction of labor in morbidly obese nulliparous women confers significantly lower odds of cesarean delivery. Among multiparous obese women, term elective induction of labor is associated with decreased odds of cesarean delivery, particularly among women with a BMI between 30 and 35.