Borghesi Yves, Labreuche Julien, Duhamel Alain, Pigeyre Marie, Deruelle Philippe
Department of Obstetrics, Centre Hospitalier Universitaire de Lille, Lille, France.
Equipe d'Accueil 2694, Santé publique: épidémiologie et qualité des soins, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France.
Int J Gynaecol Obstet. 2017 Feb;136(2):168-174. doi: 10.1002/ijgo.12032. Epub 2016 Nov 21.
To identify factors associated with cesarean delivery among women with class III obesity attempting vaginal delivery.
In a retrospective study, medical charts were reviewed for women aged 18 years or older with a singleton pregnancy of at least 37 weeks and a body mass index (calculated as weight in kilograms divided by the square of height in meters) of 40 or higher who were eligible to attempt vaginal delivery at a maternity hospital in Lille, France, between 1999 and 2012.
Among 345 eligible women, 301 (87.2%) attempted vaginal delivery; 211 (70.1%) were successful and 90 (29.9%) delivered by cesarean. The frequency of nulliparity was higher among those undergoing cesarean after a trial of labor (64 [71.1%]) than among those who delivered vaginally (57 [27.0%]; P<0.001). Induction of labor was also more frequent among those who ultimately delivered by cesarean (61 [67.8%] vs 96 [45.5%]; P<0.001). In multivariate analysis, induction of labor was an independent predictor of cesarean among women attempting vaginal delivery (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.25-4.22), whereas history of vaginal delivery was protective (OR 0.08, 95% CI 0.04-0.17).
Nulliparous women with class III obesity attempting a vaginal delivery should be warned of the high risk of cesarean delivery, especially if they require induction.
确定肥胖Ⅲ级且尝试经阴道分娩的女性剖宫产的相关因素。
在一项回顾性研究中，对1999年至2012年间在法国里尔一家妇产医院符合条件尝试经阴道分娩的18岁及以上单胎妊娠、孕周至少37周且体重指数（体重千克数除以身高米数的平方）为40或更高的女性的病历进行了审查。
在345名符合条件的女性中，301名（87.2%）尝试经阴道分娩；211名（70.1%）成功，90名（29.9%）行剖宫产。试产后行剖宫产的产妇中初产妇的比例（64例[71.1%]）高于经阴道分娩者（57例[27.0%]；P<0.001）。最终行剖宫产的产妇中引产的比例也更高（61例[67.8%]对96例[45.5%]；P<0.001）。多因素分析显示，引产是尝试经阴道分娩女性剖宫产的独立预测因素（比值比[OR]2.30，95%置信区间[CI]1.25 - 4.22），而经阴道分娩史具有保护作用（OR 0.08，95%CI 0.04 - 0.17）。
肥胖Ⅲ级且尝试经阴道分娩的初产妇应被告知剖宫产风险高，尤其是需要引产时。
