Poster Session 4
Jacqueline J. Thompson, MD, MPH
Resident
Hospital of University of Pennsylvania
Philadelphia, Pennsylvania, United States
.jpg "Lisa D. Levine, MD, MSCE (she/her/hers) photo")
Lisa D. Levine, MD, MSCE (she/her/hers)
Associate Professor, Chair, Division of MFM.
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Celeste Durnwald, MD (she/her/hers)
Associate Professor
Hospital of University of Pennsylvania
Philadelphia, Pennsylvania, United States
Rebecca F. Hamm, MD, MSCE (she/her/hers)
Assistant Professor
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania, United States
Prior studies demonstrate that patients with obesity have increased risk of cesarean delivery (CD) and longer inductions of labor (IOL), however few studies have evaluated this in the context of combination cervical ripening methods.
Study Design:
This is a secondary analysis of prospective cohort study of term, singletons with intact membranes and unfavorable cervix undergoing standardized IOL at 2 sites from 2018-2022. This analysis included only IOLs who utilized combined cervical ripening (Foley + either misoprostol or oxytocin concomitantly). Patients were stratified by BMI (< 35 vs. ≥35kg/m2). Primary outcomes included CD and labor length. Poisson regression with robust error variance was used to calculate adjusted relative risks (aRR) for CD. Time-to-event regression analyses for labor length, censored for CD, was modeled with a Cox proportional hazard model. Secondary outcomes included time Foley in, time utilizing misoprostol if applicable, dilation at and time to amniotomy, and maximum dose of oxytocin.
Results:
4,263 patients were included (BMI< 35=2,819, ≥35 =1,444). BMI groups differed by hospital site, race, insurance, parity, diagnosis of diabetes and hypertension, modified Bishop score, maternal age, gestational age, and IOL indication. Even when controlling for differences between groups, patients with BMI ≥35 had a 64% higher risk of CD than those with BMI< 35 (24.0% v. 15.3%; aRR1.64[1.41-1.90]. BMI ≥35 was not associated with differences in length of labor (HR 1.11[0.96-1.29]). While patients with obesity had a similar time utilizing Foley and misoprostol, they had longer time to and were less dilated at amniotomy. Higher maximum oxytocin doses were also utilized in those with BMI >=35.
Conclusion:
Even in the setting of combined cervical ripening methods, patients with BMI ≥35 are at increased risk of CD, although there is no difference in labor length. As our data is indicative of lower success of ripening with BMI >=35, innovative solutions for IOL are needed to improve CD rate for patients with obesity.
