Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Department of Obstetrics and Gynecology, the Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Obstet Gynecol. 2020 Mar;135(3):542-549. doi: 10.1097/AOG.0000000000003703.
To assess the risk factors associated with cesarean delivery in women with class III obesity (body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] 40 or higher) who are undergoing induction of labor.
This was a retrospective cohort of obese women with a BMI of 40 or higher and singleton pregnancy of 34 weeks of gestation or longer who underwent induction of labor at two large teaching institutions from January 2013 to December 2015. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal composite morbidity. We then assessed the applicability of using a previously developed calculator to predict the risk of cesarean delivery. The area under the receiver operating characteristic (ROC) curve was used as a measure of the ability of the calculator to discriminate between women who underwent cesarean compared with vaginal delivery.
There were 485 women with class III obesity who underwent induction during the study period. Of the 428 women who met inclusion criteria, 81.8% had a BMI of 40-50, 14.5% had a BMI of 50-60, and 3.7% had a BMI higher than 60. The overall cesarean delivery rate was 49.1% (46% with BMI 40-50, 63% with BMI 50-60, and 69% with BMI higher than 60, P=.012). Of the 428 women studied, 77.6% were black and 55% were nulliparous. Nulliparity, height, initial cervical dilation, and modified Bishop score were associated with a higher rate of cesarean delivery in multivariable models. Maternal and neonatal composite morbidity was higher in obese women who underwent cesarean delivery, compared with those who delivered vaginally. The performance of a previously developed induction calculator applied to this cohort had an area under the ROC curve of 75% (95% CI 0.70-0.79).
In women with class III obesity who underwent labor induction, the cesarean delivery rate approaches 50%. Nulliparity, height, and unfavorable cervical examination were the most significant risk factors for cesarean delivery. This information can be used to augment counseling for the obese patient who is undergoing induction.
评估患有 III 类肥胖（体重指数 [BMI，计算为体重以千克为单位除以身高以米为单位的平方] 为 40 或更高）并正在接受引产的女性中与剖宫产相关的风险因素。
这是一项回顾性队列研究，纳入了 2013 年 1 月至 2015 年 12 月在两家大型教学机构接受引产的 BMI 为 40 或更高的肥胖妇女和单胎妊娠 34 周或更长时间的孕妇。主要结局是剖宫产。次要结局包括产妇和新生儿复合发病率。然后，我们评估了使用先前开发的计算器预测剖宫产风险的适用性。接收器操作特征（ROC）曲线下的面积被用作衡量计算器区分接受剖宫产与阴道分娩的女性能力的指标。
在研究期间，有 485 名患有 III 类肥胖的女性接受了引产。在符合纳入标准的 428 名女性中，81.8%的 BMI 为 40-50，14.5%的 BMI 为 50-60，3.7%的 BMI 高于 60。总体剖宫产率为 49.1%（BMI 为 40-50 的为 46%，BMI 为 50-60 的为 63%，BMI 高于 60 的为 69%，P=.012）。在研究的 428 名女性中，77.6%为黑人，55%为初产妇。在多变量模型中，初产妇、身高、初始宫颈扩张和改良 Bishop 评分与剖宫产率较高相关。与阴道分娩的肥胖女性相比，行剖宫产的肥胖女性的产妇和新生儿复合发病率更高。先前开发的引产计算器在该队列中的表现，ROC 曲线下面积为 75%（95%CI 0.70-0.79）。
在接受引产的 III 类肥胖女性中，剖宫产率接近 50%。初产妇、身高和不利的宫颈检查是剖宫产的最重要危险因素。这些信息可用于增强对接受引产的肥胖患者的咨询。
