The impact of body mass index on labour management and mode of delivery: A retrospective matched cohort study

IF 1.4 4区医学 Q3 OBSTETRICS & GYNECOLOGY Australian & New Zealand Journal of Obstetrics & Gynaecology Pub Date : 2023-11-14 DOI:10.1111/ajo.13769

Kan-feng Zheng, Madeleine N. Jones, Ben W. Mol, Daniel L. Rolnik

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Abstract

Aim

This study aims to examine the association between body mass index (BMI) and mode of delivery, progression of labour, and intrapartum interventions.

Methods

This was a retrospective matched cohort study including Class III obese (BMI ≥40 kg/m²) and normal BMI (BMI <25 kg/m²) women planning a vaginal birth who had a live, singleton delivery from January 2015 to December 2018. Patients were matched (1:1) based on age, gestational age, parity, onset of labour and birth weight. The primary outcome was caesarean delivery (CD). Secondary outcomes were delivery outcomes, intrapartum management and interventions. Rates of each outcome were compared with matched analysis, and duration of labour with time-to-event analysis.

Results

We studied two groups of 300 pregnant women. The CD rate was significantly higher for obese women than the normal BMI cohort (19.3% vs 13.3%; risk ratio (RR) 1.43, 95% CI 1.02–1.98, P = 0.035). Cervical dilation prior to CD for failure to progress was slower in obese than normal BMI (0.04 vs 0.16 cm/h). The obese cohort had a longer duration of labour in those who underwent induction (13.70 vs 11.48 h, P = 0.024). Intrapartum intervention rates were higher for obese women, with significant differences in rates of fetal scalp electrodes (72.7% vs 22.7%, RR 3.20, 95% CI 2.58–3.99, P < 0.001), intrauterine pressure catheters (18.3% vs 0%, P < 0.001), epidural analgesia (44.0% vs 37.0%, RR 1.20, 95% CI 1.01–1.44, P = 0.040) and fetal scalp lactate sampling (8.0% vs 3.0%, RR = 2.67, 95% CI 1.33–5.33, P = 0.004).

Conclusion

Class III obesity is associated with an increased risk of CD and intrapartum interventions.

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体重指数对劳动管理和分娩方式的影响:一项回顾性匹配队列研究。

目的:本研究旨在探讨体重指数(BMI)与分娩方式、产程和产时干预措施之间的关系。方法:这是一项回顾性匹配队列研究，包括2015年1月至2018年12月计划顺产的III级肥胖(BMI≥40 kg/m2)和正常BMI (BMI 2)女性。患者根据年龄、胎龄、胎次、分娩开始和出生体重进行1:1的匹配。主要结局为剖腹产(CD)。次要结局是分娩结局、产时管理和干预措施。每个结果的发生率与匹配分析进行比较，分娩持续时间与事件时间分析进行比较。结果:我们研究了两组300名孕妇。肥胖女性的乳糜泻发生率明显高于正常BMI组(19.3% vs 13.3%;风险比(RR) 1.43, 95% CI 1.02 ~ 1.98, P = 0.035)。肥胖患者在CD前未进展的宫颈扩张比正常BMI患者慢(0.04 vs 0.16 cm/h)。肥胖组接受引产的分娩持续时间较长(13.70 h vs 11.48 h, P = 0.024)。肥胖妇女的产时干预率更高，胎儿头皮电极率有显著差异(72.7% vs 22.7%， RR 3.20, 95% CI 2.58-3.99, P)。结论:III级肥胖与CD和产时干预风险增加有关。

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来源期刊

Australian & New Zealand Journal of Obstetrics & Gynaecology 医学-妇产科学

CiteScore

3.40

自引率

11.80%

发文量

165

审稿时长

4-8 weeks

期刊介绍： The Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) is an editorially independent publication owned by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the RANZCOG Research foundation. ANZJOG aims to provide a medium for the publication of original contributions to clinical practice and/or research in all fields of obstetrics and gynaecology and related disciplines. Articles are peer reviewed by clinicians or researchers expert in the field of the submitted work. From time to time the journal will also publish printed abstracts from the RANZCOG Annual Scientific Meeting and meetings of relevant special interest groups, where the accepted abstracts have undergone the journals peer review acceptance process.