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Am J Perinatol 2021; 38(14): 1453-1458
DOI: 10.1055/s-0041-1732459
SMFM Fellowship Series Article

Risk of Cesarean Delivery for Women with Obesity Using a Standardized Labor Induction Protocol

Rebecca F. Hamm
1   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
2   Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
,
Christina P. Teefey
3   Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Cara D. Dolin
1   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Celeste P. Durnwald
1   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Sindhu K. Srinivas
1   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
2   Leonard Davis Institute of Health Economics, Perelman School of Medicine, Philadelphia, Pennsylvania
,
Lisa D. Levine
1   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations Funding This study was funded in part by a career development award in Women's Reproductive Health Research, grant no.: K12-HD001265–16 [LL] and T32 Training Grant in Reproductive Epidemiology, grant no.: T32-HD007440 [RH].
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Abstract

Objective We aimed to determine the risk of cesarean among women with obesity undergoing labor induction within a prospective trial that utilized a standardized labor protocol.

Study Design This was a secondary analysis of a randomized trial of induction methods. Term (≥37 weeks) women with intact membranes undergoing induction with an unfavorable cervix (Bishop's score ≤6 and dilation ≤2 cm) were included. The trial utilized a labor protocol that standardized induction and active labor management, with recommendations for interventions at particular time points. Only women with a recorded body mass index (BMI) at prenatal care start were included in this analysis. The primary outcome was cesarean delivery compared between obese (≥30 kg/m2) and nonobese (<30 kg/m2) women. Indication for cesarean was also evaluated.

Results A total of 465 women were included: 207 (44.5%) obese and 258 (55.5%) nonobese. Women with obesity had a higher risk of cesarean compared with women without obesity (33.3 vs. 23.3%, p = 0.02), even when adjusting for parity, weight change over pregnancy, and indication for induction (adjusted relative risk [aRR] = 1.79, 95% confidence interval [CI]: [1.34–2.39]). Compared with women without obesity, women with obesity had a higher risk of failed induction (47.8 vs. 26.7%, p = 0.01) without a difference in arrest of active phase (p = 0.39), arrest of descent (p = 0.95) or fetal indication (p = 0.32), despite adherence to a standardized labor protocol.

Conclusion Compared with women without obesity, women with obesity undergoing an induction are at increased risk of cesarean, in particular a failed induction, even within the context of standardized induction management. As standardized practices limit provider variation in labor management, this study may support physiologic differences in labor processes secondary to obesity.

Key Points

  • Even with a standardized induction protocol, women with obesity are at higher risk of cesarean.

  • In particular, women with obesity are at increased risk of cesarean for failed induction.

  • These findings support a possible biologic relationship between obesity and failed induction.

Keywords

obesity - induction of labor - cesarean delivery - failed induction - labor protocol


Publication History

Received: 08 October 2020

Accepted: 17 June 2021

Article published online:
19 July 2021

© 2021. Thieme. All rights reserved.

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