J Midwifery Womens Health. 2019 Jan;64(1):55-67. doi: 10.1111/jmwh.12935. Epub 2019 Jan 16.
Studies have shown that women with obesity have longer labors. The purpose of this systematic review and meta-analysis is to examine existing evidence regarding labor induction in women with obesity, including processes and outcomes. The primary outcome was cesarean birth following labor induction. Secondary outcomes were the timing and dosage of prostaglandins, the success of mechanical cervical ripening methods, and synthetic oxytocin dose and timing.
Searches were performed in PubMed, MEDLINE, Embase, CINAHL, EBSCO, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Effects, Google Scholar, and ClinicalTrials.gov. Searches were limited to studies published in English after 1990. Ten studies published between 2009 and 2017 were included in this review. All were observational studies comparing processes and outcomes of induction of labor in relation to maternal body mass index. The primary outcome was cesarean birth following labor induction. We assessed heterogeneity using Cochran's Q test and tau-squared and I statistics. We also calculated fixed-effect models to estimate pooled relative risks and weighted mean differences.
Ten cohort studies met inclusion criteria; 8 studies had data available for a meta-analysis of the primary outcome. Cesarean birth was more common among women with obesity compared with women of normal weight following labor induction (Mantel-Haenszel fixed-effect odds ratio, 1.82; 95% CI, 1.55-2.12; P < .001). Maternal obesity was associated with a longer time to birth, higher doses of prostaglandins, less frequent success of cervical ripening methods, and higher dose of synthetic oxytocin, as well as a longer time to birth after oxytocin use.
Women with obesity are more likely than women with a normal weight to end labor induction with cesarean birth. Additionally, women with obesity require longer labor inductions involving larger, more frequent applications of both cervical ripening methods and synthetic oxytocin.
研究表明，肥胖女性的分娩时间较长。本系统评价和荟萃分析的目的是检查关于肥胖女性引产的现有证据，包括过程和结果。主要结局是引产后继发剖宫产。次要结局为前列腺素的应用时机和剂量、机械性宫颈成熟方法的成功率，以及缩宫素的合成剂量和应用时机。
在 PubMed、MEDLINE、Embase、CINAHL、EBSCO、Cochrane 系统评价数据库、效应摘要数据库、Google Scholar 和 ClinicalTrials.gov 中进行了检索。检索仅限于 1990 年后发表的英文研究。本综述纳入了 2009 年至 2017 年期间发表的 10 项研究。所有研究均为比较肥胖产妇与正常体重产妇引产过程和结局的观察性研究。主要结局是引产后继发剖宫产。我们使用 Cochran's Q 检验和 tau-squared 和 I 统计量评估异质性。我们还计算了固定效应模型，以估计汇总相对风险和加权均数差。
10 项队列研究符合纳入标准；8 项研究有关于主要结局的meta 分析数据。与正常体重产妇相比，肥胖产妇在引产后继发剖宫产的可能性更高（Mantel-Haenszel 固定效应优势比，1.82；95%CI，1.55-2.12；P<.001）。与体重正常的产妇相比，肥胖产妇的分娩时间更长，前列腺素剂量更高，宫颈成熟方法成功率更低，合成缩宫素剂量更高，缩宫素使用后分娩时间也更长。
肥胖女性比体重正常的女性更有可能在引产时以剖宫产结束分娩。此外，肥胖女性需要更长的引产时间，需要更频繁、更大剂量地应用宫颈成熟方法和合成缩宫素。
