Poster Session 3
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States
Easha Patel, MD (she/her/hers)
Maternal Fetal Medicine Fellow
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Kirat Sandhu, MD
Resident
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Stacey Ehrenberg, MD (she/her/hers)
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Cara D. Dolin, MD, MPH
Assistant Professor of Obstetrics and Gynecology
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Maeve Hopkins, MD
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Maternal obesity is a known risk factor for cesarean delivery, but risk may be differential based on obesity severity. This study explores predictors of successful vaginal delivery in patients with class 3 obesity undergoing induction of labor.
Study Design:
This is a retrospective cohort study of singleton deliveries with BMI > 40 following induction of labor > 20 weeks at a multi-hospital academic health system from 1/1/2022-6/30/2024. Patients with prior cesarean were excluded. The primary outcome was vaginal delivery. Patient clinical data were extracted from the medical record and demographics, clinical risk factors, and outcomes were compared in univariable analyses by mode of delivery. Based on identified significance in these analyses, a multivariable logistic regression model was utilized to evaluate the impact of potential predictors on adjusted likelihood of vaginal delivery.
Results:
610 total patients were included, 457 of whom delivered vaginally (74.9%). Patients who delivered vaginally had lower pregravid BMI (43.6 v. 44.5, p = 0.01) and lower delivery BMI (46.3 v. 49.4, p < 0.01) [Table 1]. Patients with Medicaid compared to commercial insurance were more likely to delivery vaginally, as were patients who were not nulliparous, did not require cervical ripening at induction, and did not have severe preeclampsia. Patients who delivered by cesarean had higher rates of NICU admission and extended postpartum length of stay, as well as blood loss. Nulliparity was identified as the most significant negative predictor of vaginal delivery on adjusted analysis (aOR 0.01, 95% CI 0.06-0.18, p < 0.01) [Table 2]. Other significant negative predictors were higher delivery BMI, cervical ripening, and chronic hypertension.
Conclusion:
Nulliparous patients with class 3 obesity who require cervical ripening have significantly lower odds of vaginal delivery. These data can help guide counseling and physician decision making surrounding optimizing induction of labor for this patient group.