Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor

Abstract

Objective We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m²) undergoing induction of labor.

Study Design This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates.

Results Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21–3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47–6.58) only in nulliparous women.

Conclusion Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.

Keywords

amniotomy - induction of labor - obesity - cesarean delivery

Note

This study was presented in poster format at the Society for Maternal-Fetal Medicine's 37th Annual Pregnancy Meeting in Las Vegas, NV, on January 23–28, 2017.

• References

• 1 Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315 (21) 2284-2291
• 2 Weiss JL, Malone FD, Emig D. , et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol 2004; 190 (04) 1091-1097
• 3 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
• 4 Norman SM, Tuuli MG, Odibo AO, Caughey AB, Roehl KA, Cahill AG. The effects of obesity on the first stage of labor. Obstet Gynecol 2012; 120 (01) 130-135
• 5 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (02) 219-224
• 6 Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J Obstet Gynaecol Can 2013; 35 (07) 606-611
• 7 Ghafarzadeh M, Moeininasab S, Namdari M. Effect of early amniotomy on dystocia risk and cesarean delivery in nulliparous women: a randomized clinical trial. Arch Gynecol Obstet 2015; 292 (02) 321-325
• 8 Macones GA, Cahill A, Stamilio DM, Odibo AO. The efficacy of early amniotomy in nulliparous labor induction: a randomized controlled trial. Am J Obstet Gynecol 2012; 207 (05) 403.e1-403.e5
• 9 Wei S, Wo BL, Qi HP. , et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2013; 8 (08) CD006794
• 10 Mercer BM, McNanley T, O'Brien JM, Randal L, Sibai BM. Early versus late amniotomy for labor induction: a randomized trial. Am J Obstet Gynecol 1995; 173 (04) 1321-1325
• 11 Smid MC, Kearney MS, Stamilio DM. Extreme obesity and postcesarean wound complications in the maternal-fetal medicine unit cesarean registry. Am J Perinatol 2015; 32 (14) 1336-1341
• 12 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
• 13 Edwards RK, Szychowski JM, Berger JL. , et al. Foley catheter compared with the controlled-release dinoprostone insert: a randomized controlled trial. Obstet Gynecol 2014; 123 (06) 1280-1287
• 14 Battarbee AN, Palatnik A, Peress DA, Grobman WA. Association of early amniotomy after Foley balloon catheter ripening and duration of nulliparous labor induction. Obstet Gynecol 2016; 128 (03) 592-597
• 15 Edwards RK, Szychowski JM, Bodea-Braescu AV, Biggio JR, Lin MG. Foley catheter for induction of labor: potential barriers to adopting the technique. J Perinatol 2015; 35 (12) 996-999
• 16 Osterman MJ, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; (155) 1-8
• 17 ACOG Practice Bulletin No 156: Obesity in Pregnancy. Obstet Gynecol 2015; 126 (06) e112-e126
• 18 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
• 19 Kawakita T, Reddy UM, Landy HJ, Iqbal SN, Huang CC, Grantz KL. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol 2016; 215 (04) 515.e1-515.e9
• 20 Caughey AB, Cahill AG, Guise JM, Rouse DJ. ; American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193