Download PDF
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

Yossi Bart 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Rachel L. Wiley
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Ipsita Ghose 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Michal Fishel Bartal
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
2   Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
,
Khalil M. Chahine
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Suneet P. Chauhan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Sean Blackwell
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
,
Baha M. Sibai
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, Texas
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

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

Supplementary Material



Publication History

Received: 15 May 2024

Accepted: 29 August 2024

Accepted Manuscript online:
02 September 2024

Article published online:
27 September 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007-2008 to 2015-2016. JAMA 2018; 319 (16) 1723-1725
    CrossrefPubMedSearch in Google Scholar
  • 2 Afshin A, Forouzanfar MH, Reitsma MB. et al; GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017; 377 (01) 13-27
    CrossrefPubMedSearch in Google Scholar
  • 3 Robinson HE, O'Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005; 106 (06) 1357-1364
    CrossrefPubMedSearch in Google Scholar
  • 4 Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005; 112 (06) 768-772
    CrossrefPubMedSearch in Google Scholar
  • 5 Dinsmoor MJ, Ugwu LG, Bailit JL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Short-term neonatal outcomes of pregnancies complicated by maternal obesity. Am J Obstet Gynecol MFM 2023; 5 (04) 100874
    CrossrefPubMedSearch in Google Scholar
  • 6 Wood R, Freret TS, Clapp M, Little S. Rates of induction of labor at 39 weeks and cesarean delivery following publication of the ARRIVE Trial. JAMA Netw Open 2023; 6 (08) e2328274
    CrossrefPubMedSearch in Google Scholar
  • 7 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114 (2 Pt 1): 386-397
    CrossrefPubMedSearch in Google Scholar
  • 8 Arrowsmith S, Wray S, Quenby S. Maternal obesity and labour complications following induction of labour in prolonged pregnancy. BJOG 2011; 118 (05) 578-588
    CrossrefPubMedSearch in Google Scholar
  • 9 American College of Obstetricians and Gynecologists. Obesity in Pregnancy: ACOG Practice Bulletin, Number 230. Obstet Gynecol 2021; 137 (06) e128-e144
    CrossrefPubMedSearch in Google Scholar
  • 10 Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103 (03) 452-456
    PubMedSearch in Google Scholar
  • 11 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8 (05) 385-394
    CrossrefPubMedSearch in Google Scholar
  • 12 Borghesi Y, Labreuche J, Duhamel A, Pigeyre M, Deruelle P. Risk of cesarean delivery among pregnant women with class III obesity. Int J Gynaecol Obstet 2017; 136 (02) 168-174
    CrossrefPubMedSearch in Google Scholar
  • 13 Paidas Teefey C, Reforma L, Koelper NC. et al. Risk factors associated with cesarean delivery after induction of labor in women with class III obesity. Obstet Gynecol 2020; 135 (03) 542-549
    CrossrefPubMedSearch in Google Scholar
  • 14 Subramaniam A, Jauk VC, Goss AR, Alvarez MD, Reese C, Edwards RK. Mode of delivery in women with class III obesity: planned cesarean compared with induction of labor. Am J Obstet Gynecol 2014; 211 (06) 700.e1-700.e9
    CrossrefPubMedSearch in Google Scholar
  • 15 Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin Jr JN. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol 2001; 185 (02) 349-354
    CrossrefPubMedSearch in Google Scholar
  • 16 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief 2020; (360) 1-8
    PubMedSearch in Google Scholar
  • 17 Freret TS, Woods GT, James KE, Kaimal AJ, Clapp MA. Incidence of and risk factors for failed induction of labor using a contemporary definition. Obstet Gynecol 2021; 137 (03) 497-504
    CrossrefPubMedSearch in Google Scholar
  • 18 Homer CS, Kurinczuk JJ, Spark P, Brocklehurst P, Knight M. Planned vaginal delivery or planned caesarean delivery in women with extreme obesity. BJOG 2011; 118 (04) 480-487
    CrossrefPubMedSearch in Google Scholar
  • 19 American College of Obstetricians and Gynecologists. Obstetric Care Consensus No. 1: Safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
    CrossrefPubMedSearch in Google Scholar
  • 20 Blomberg M. Maternal obesity, mode of delivery, and neonatal outcome. Obstet Gynecol 2013; 122 (01) 50-55
    CrossrefPubMedSearch in Google Scholar