Stafford Irene A, Moustafa Ahmed S Z, Spoo Lauren, Berra Alexandra, Burgess Angela, Turrentine Mark
Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, Texas.
Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, Flint, Michigan.
AJP Rep. 2021 Apr;11(2):e105-e112. doi: 10.1055/s-0041-1732409. Epub 2021 Jul 15.
Data are limited concerning rates of perinatal complications in women with a body mass index (BMI) ≥40 kg/m2 compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. The aim of the study is to evaluate labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent management. This retrospective study included low-risk women admitted for delivery between April 2014 and April 2017 after the labor guidelines were implemented. BMI closest to delivery was used for analysis. Women with cesarean for nonreassuring fetal status were excluded. Guideline adherence decreased with increasing BMI, with 93% adherence among women of normal weight compared to 81% for class III obese women ( < 0.0001). Among women who had guideline-adherent management, there was increased rates of cesarean among class III versus other obesity classes; however, there were no differences in rates of infectious morbidity ( = 0.98) or hemorrhage ( = 0.93). Although newborns of women with class III obesity had higher rates of meconium at birth, neonatal outcomes were not different with increasing maternal BMI ( = 0.65). There were no differences in adverse perinatal outcomes with increasing BMI.
与其他体重指数（BMI）类别的女性相比，在应用安全预防初次剖宫产的指南时，关于BMI≥40kg/m²的女性围产期并发症发生率的数据有限。本研究的目的是评估按BMI类别划分的分娩指南依从性，并比较采用指南依从性管理的不同BMI类别的围产期结局。这项回顾性研究纳入了2014年4月至2017年4月实施分娩指南后入院分娩的低风险女性。分析采用最接近分娩时的BMI。因胎儿状况不佳而行剖宫产的女性被排除。指南依从性随BMI升高而降低，正常体重女性的依从率为93%，而III级肥胖女性为81%（P<0.0001）。在接受指南依从性管理的女性中，III级肥胖女性的剖宫产率高于其他肥胖类别；然而，感染性发病率（P=0.98）或出血率（P=0.93）没有差异。虽然III级肥胖女性的新生儿出生时胎粪发生率较高，但随着母亲BMI升高，新生儿结局并无差异（P=0.65）。随着BMI升高，不良围产期结局没有差异。
