Maged Ahmed M, El-Semary Ali M, Marie Heba M, Belal Doaa S, Hany Ayman, Taymour Mohammad A, Omran Eman F, Elbaradie Sahar M Y, Mohamed Mohamed A Kamal
Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt.
Department of Obstetrics and Gynecology, Fayoum University, Fayoum, Egypt.
Arch Gynecol Obstet. 2018 Jul;298(1):45-50. doi: 10.1007/s00404-018-4767-8. Epub 2018 Apr 2.
To test the hypothesis that there is a higher rate of unsuccessful induction of labor (IOL) in post-term obese pregnant women compared to non-obese ones.
In this prospective cohort study, 144 obese (BMI > 30) and 144 non-obese (BMI < 29.9) post-term (> 41 weeks) pregnant women were recruited. IOL was done by misoprostol or amniotomy and oxytocin infusion according to the Bishop score. Comparison of percentage of failed IOL in both groups (primary outcome) was performed by the Chi-test. Logistic regression and multivariable regression were performed to assess the odds ratio (OR) of cesarean section (CS) and coefficient of delay in labor till vaginal delivery (VD) in obese versus (vs) non-obese groups. Adjustment for gestational age, parity, Bishop Score, membrane rupture and amniotic fluid index was done in both regression analyses.
CS rate was significantly higher in obese group [26.4 vs 15.9%; difference in proportion (95% CI) 0.1 (0.01, 0.19); P value 0.02]. 106 (73.6%) obese women and 121 (84.1%) non-obese women delivered vaginally. In addition, the duration till VD was significantly higher in obese group (22 vs 19 h, P value 0.01). After adjustment for possible confounding factors, the CS was still higher in the obese group in comparison to non-obese group (OR 2.02; 95% CI 1.1, 3.7; P value 0.02). This finding suggested that obesity was an independent factor for failure of IOL. In addition, after adjustment for these confounders, obesity had the risk of increasing labor duration by 2.3 h (95% CI 0.1, 4.5) in cases that ended in VD.
Based on our results, we conclude that there is a higher risk of CS in obese postdate pregnant women undergoing IOL in comparison to non-obese counterparts. Therefore, obstetricians should pay more attention to advising pregnant women about optimal weight gain during pregnancy and counseling about the chances of VD in cases of IOL. CLINCALTRIAL.
NCT02788305.
检验过期妊娠肥胖孕妇与非肥胖孕妇相比引产失败率更高这一假设。
在这项前瞻性队列研究中，招募了144名肥胖（BMI＞30）和144名非肥胖（BMI＜29.9）的过期妊娠（＞41周）孕妇。根据 Bishop 评分，采用米索前列醇或羊膜穿刺术及缩宫素静脉滴注进行引产。通过卡方检验比较两组引产失败的百分比（主要结局）。进行逻辑回归和多变量回归以评估肥胖组与非肥胖组剖宫产（CS）的比值比（OR）以及直至阴道分娩（VD）的产程延迟系数。在两个回归分析中均对孕周、产次、Bishop 评分、胎膜破裂和羊水指数进行了校正。
肥胖组的剖宫产率显著更高[26.4%对15.9%；比例差异（95%CI）0.1（0.01，0.19）；P值0.02]。106名（73.6%）肥胖妇女和121名（84.1%）非肥胖妇女经阴道分娩。此外，肥胖组直至阴道分娩的持续时间显著更长（22小时对19小时，P值0.01）。在对可能的混杂因素进行校正后，肥胖组的剖宫产率仍高于非肥胖组（OR 2.02；95%CI 1.1，3.7；P值0.02）。这一发现表明肥胖是引产失败的一个独立因素。此外，在对这些混杂因素进行校正后，在以阴道分娩结束的病例中，肥胖有使产程增加2.3小时的风险（95%CI 0.1，4.5）。
根据我们的结果，我们得出结论，与非肥胖的过期妊娠孕妇相比，肥胖的过期妊娠孕妇引产时剖宫产风险更高。因此，产科医生应更加重视就孕期最佳体重增加向孕妇提供建议，并就引产时阴道分娩的可能性提供咨询。临床试验。
NCT02788305。
