Am J Perinatol 2020; 37(04): 349-356
DOI: 10.1055/s-0039-1694982
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

1   Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Women's and Infant Services, Washington, District of Columbia
,
Elizabeth M. Coviello
1   Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Women's and Infant Services, Washington, District of Columbia
,
Daphnie Drassinower
2   Division of Maternal-Fetal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
Funding None.
Further Information

Publication History

28 January 2019

09 July 2019

Publication Date:
20 August 2019 (online)

Abstract

Objective Our objective was to determine if obese women are more likely to require oxytocin rates > 20 mU/min to achieve vaginal delivery, compared with normal weight women.

Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital.

Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI >30.0 kg/m2), 12% were classified as class III obesity (BMI >40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of >20 mU/min. Doses of oxytocin >20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p < 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p < 0.001).

Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.

Note

The findings of this study were presented at the 38th Annual Pregnancy Meeting of the Society of Maternal-Fetal Medicine, January 29–February 3, 2018, Dallas, TX.


 
  • References

  • 1 Maeder AB, Vonderheid SC, Park CG. , et al. Titration of intravenous oxytocin infusion for postdates induction of labor across body mass index groups. J Obstet Gynecol Neonatal Nurs 2017; 46 (04) 494-507
  • 2 Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United states, 2011–2014. NCHS Data Brief 2015; 219 (219) 1-8
  • 3 ACOG practice bulletin no 156: obesity in pregnancy. Obstet Gynecol 2015; 126 (06) e112-e126
  • 4 Dolin CD, Kominiarek MA. Pregnancy in women with obesity. Obstet Gynecol Clin North Am 2018; 45 (02) 217-232
  • 5 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
  • 6 Robinson BK, Mapp DC, Bloom SL. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the Maternal-Fetal Medicine Units Network (MFMU). Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol 2011; 118 (06) 1309-1313
  • 7 Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol 2011; 205 (02) 128.e1-128.e7
  • 8 Yogev Y, Catalano PM. Pregnancy and obesity. Obstet Gynecol Clin North Am 2009; 36 (02) 285-300
  • 9 Carlson NS, Corwin EJ, Lowe NK. Oxytocin augmentation in spontaneously laboring, nulliparous women: multilevel assessment of maternal BMI and oxytocin dose. Biol Res Nurs 2017; 19 (04) 382-392
  • 10 Hill M, Reed KL, Cohen WR. Oxytocin utilization for labor induction in obese and lean women. J Perinat Med 2015; 43 (06) 703-706
  • 11 Roloff K, Peng S, Sanchez-Ramos L, Valenzuela GJ. Cumulative oxytocin dose during induction of labor according to maternal body mass index. Int J Gynaecol Obstet 2015; 131 (01) 54-58
  • 12 Soni S, Chivan N, Cohen WR. Effect of maternal body mass index on oxytocin treatment for arrest of dilatation. J Perinat Med 2013; 41 (05) 517-521
  • 13 Verdiales M, Pacheco C, Cohen WR. The effect of maternal obesity on the course of labor. J Perinat Med 2009; 37 (06) 651-655
  • 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
  • 15 Frey HA, Tuuli MG, England SK. , et al. Factors associated with higher oxytocin requirements in labor. J Matern Fetal Neonatal Med 2015; 28 (13) 1614-1619
  • 16 Reinl EL, Goodwin ZA, Raghuraman N. , et al. Novel oxytocin receptor variants in laboring women requiring high doses of oxytocin. Am J Obstet Gynecol 2017; 217 (02) 214.e1-214.e8
  • 17 Wei SQ, Luo ZC, Qi HP, Xu H, Fraser WD. High-dose vs low-dose oxytocin for labor augmentation: a systematic review. Am J Obstet Gynecol 2010; 203 (04) 296-304
  • 18 Budden A, Chen LJ, Henry A. High-dose versus low-dose oxytocin infusion regimens for induction of labour at term. Cochrane Database Syst Rev 2014; 10 (10) CD009701
  • 19 Buhimschi CS, Buhimschi IA, Malinow AM, Weiner CP. Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol 2004; 103 (02) 225-230
  • 20 Kobayashi N, Lim BH. Induction of labour and intrapartum care in obese women. Best Pract Res Clin Obstet Gynaecol 2015; 29 (03) 394-405
  • 21 Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA. Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstet Gynecol 2009; 114 (06) 1315-1321
  • 22 Lassiter JR, Holliday N, Lewis DF, Mulekar M, Abshire J, Brocato B. Induction of labor with an unfavorable cervix: how does BMI affect success? (‡). J Matern Fetal Neonatal Med 2016; 29 (18) 3000-3002
  • 23 Knibbe CA, Brill MJ, van Rongen A, Diepstraten J, van der Graaf PH, Danhof M. Drug disposition in obesity: toward evidence-based dosing. Annu Rev Pharmacol Toxicol 2015; 55: 149-167
  • 24 Kominiarek MA, Zhang J, Vanveldhuisen P, Troendle J, Beaver J, Hibbard JU. Contemporary labor patterns: the impact of maternal body mass index. Am J Obstet Gynecol 2011; 205 (03) 244.e1-244.e8
  • 25 Azaïs H, Leroy A, Ghesquiere L, Deruelle P, Hanssens S. Effects of adipokines and obesity on uterine contractility. Cytokine Growth Factor Rev 2017; 34: 59-66
  • 26 Ruhstaller K. Induction of labor in the obese patient. Semin Perinatol 2015; 39 (06) 437-440
  • 27 Carlson NS, Hernandez TL, Hurt KJ. Parturition dysfunction in obesity: time to target the pathobiology. Reprod Biol Endocrinol 2015; 13: 135,015–0129–6
  • 28 Moynihan AT, Hehir MP, Glavey SV, Smith TJ, Morrison JJ. Inhibitory effect of leptin on human uterine contractility in vitro. Am J Obstet Gynecol 2006; 195 (02) 504-509
  • 29 Grotegut CA, Gunatilake RP, Feng L, Heine RP, Murtha AP. The influence of maternal body mass index on myometrial oxytocin receptor expression in pregnancy. Reprod Sci 2013; 20 (12) 1471-1477
  • 30 Higgins CA, Martin W, Anderson L. , et al. Maternal obesity and its relationship with spontaneous and oxytocin-induced contractility of human myometrium in vitro. Reprod Sci 2010; 17 (02) 177-185
  • 31 Garabedian MJ, Williams CM, Pearce CF, Lain KY, Hansen WF. Extreme morbid obesity and labor outcome in nulliparous women at term. Am J Perinatol 2011; 28 (09) 729-734
  • 32 Gunatilake RP, Smrtka MP, Harris B. , et al. Predictors of failed trial of labor among women with an extremely obese body mass index. Am J Obstet Gynecol 2013; 209 (06) 562.e1-562.e5
  • 33 Yee LM, Costantine MM, Rice MM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Racial and ethnic differences in utilization of labor management strategies intended to reduce cesarean delivery rates. Obstet Gynecol 2017; 130 (06) 1285-1294