Poster Session 4
Category: Epidemiology
Poster Session 4
Yossi Bart, MD
MFM fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Michal Fishel Bartal, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Hector Mendez-Figueroa, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sean C. Blackwell, MBA, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
To compare maternal and neonatal outcomes between labor induction and cesarean delivery (CD) without labor among term nulliparous individuals with class III obesity (body mass index [BMI] ≥ 40 kg/m2).
Study Design:
A secondary analysis of the Assessment of Perinatal Excellence (APEX) database, including all nulliparous singleton deliveries ≥ 37 weeks with BMI ≥ 40 kg/m2 at delivery. Individuals with spontaneous labor or fetal malformations were excluded. The primary outcome was a composite maternal adverse outcome (CMAO) that included 12 hemorrhagic, operative, and infectious complications, along with venous thromboembolism and death. The composite neonatal adverse outcome (CNAO) included mortality and key morbidity outcomes. Multivariable logistic regression was used to calculate adjusted odds ratio (aOR) with 95% confidence intervals (CI).
Results:
Out of 115,502, a total of 1,922 (2%) individuals met inclusion criteria: 305 (16%) underwent primary CD without labor, while 1,617 (84%) underwent labor induction. Induced individuals were younger, had lower rates of diabetes mellitus, and higher rates of alcohol use and later gestational age at delivery. Of those induced, 893 (55%) ultimately had an indicated CD (Figure). Among those who delivered vaginally, 99 (14%) ended up with a 3rd/4th degree tear or shoulder dystocia. Compared with CD without labor, the CMAO rate was higher following induction (aOR 2.35, 95% CI 1.21-4.57; Table). In a sensitivity analysis excluding 3rd/4th degree tears, CMAO rates did not differ (aOR 1.32, 95% CI 0.66-2.62). Induction was associated with higher rates of neonatal admission to intensive or intermediate care (aOR 1.59, 95% CI 1.05-2.42); the CNAO rate did not differ between groups (aOR 1.60, 95% CI 0.95-2.71).
Conclusion:
In term nulliparas with class III obesity, labor induction led to CD in over 50% of the cases and was associated with a higher CMAO rate compared to CD without labor. These findings support individualized counseling and suggest the need for a comparative prospective study evaluating the mode of scheduled delivery in this population.