Neonatal outcome by planned mode of delivery in women with a body mass index of 35 or more: a retrospective cohort study

K. Tzadikevitch-Geffen, N. Melamed, A. Aviram, A. E. Sprague, C. Maxwell, J. F.R. Barrett, E. Mei-Dan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To compare neonatal outcomes of women with a body mass index (BMI) of ≥35 kg/m2 who underwent a trial of labour with those of women who underwent a planned primary caesarean section (CS). Design: A retrospective cohort study of births between April 2012 and March 2014. Setting: A provincial database: Better Outcomes Registry & Network (BORN) Ontario, Canada. Population: A cohort of 8752 women with a BMI of ≥35 kg/m2 who had a singleton birth at 38–42 weeks of gestation. Methods: Neonatal outcomes were compared between women who underwent a trial of labour (with either a successful vaginal birth or intrapartum CS) and those who underwent a planned CS. Main outcome measure: A composite of any of the following outcomes: intrapartum neonatal death, neonatal intensive care unit admission, 5-minute Apgar score of <7 or umbilical artery pH of <7.1. Results: During the study period, 8433 (96.4%) women had a trial of labour and 319 (3.6%) had a planned CS. Intrapartum CS was performed in 1644 (19.5%) cases. There was no association between planned mode of delivery and the primary outcome (aOR 0.80, 95% CI 0.59–1.07). The primary outcome was lower among women who had a successful trial of labour (aOR 0.67, 95% CI 0.50–0.91) and was higher among women who had a failed trial of labour (aOR 1.74, 95% CI 1.21–2.48), compared with women who underwent a planned CS. Conclusions: In women with a BMI of ≥35 kg/m2 at a gestational age of 38–42 weeks, neonatal outcomes are comparable between planned vaginal delivery and planned CS, although a failed trial of labour is at risk of adverse neonatal outcome. Tweetable abstract: Neonatal outcomes are not affected by planned mode of delivery in women who are obese, with a BMI of ≥35 kg/m2.

Original languageEnglish
Pages (from-to)900-906
Number of pages7
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Volume128
Issue number5
DOIs
StatePublished - Apr 2021
Externally publishedYes

Keywords

  • Body mass index
  • caesarean delivery
  • neonatal outcome
  • obesity
  • planned mode of delivery
  • vaginal delivery

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