Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa.
J Obstet Gynaecol. 2022 Nov;42(8):3450-3455. doi: 10.1080/01443615.2022.2128730. Epub 2022 Oct 4.
Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. We conducted a retrospective observational study on otherwise uncomplicated women with a body mass index (BMI) ≥ 40 kg/m where, having reached term, induction of labour (IOL) was planned, to prevent prolonged pregnancy. The primary aim was to describe delivery outcomes and short-term maternal and perinatal adverse events. Of 117 cases included, 69 (59%) laboured spontaneously before the induction date, while 48 (41%) required an IOL. Of 48 patients that underwent an IOL, 22 (45.8%) achieved vaginal delivery, compared to 55 (79.7%) who laboured spontaneously ( = <.001). Twenty-two (18.8%) of the 117 babies weighed more than 4000 g, with 13 of these delivered vaginally. Overall, term patients with morbid obesity who laboured spontaneously before requiring induction, had a high rate of vaginal delivery. However, when IOL was required, the rate of caesarean delivery rose dramatically.Impact statement Morbid obesity and prolonged pregnancy are independently associated with adverse delivery and perinatal outcomes. Induction of labour (IOL) increases the workload in busy units. These results help inform accurate counselling on delivery outcomes, which is integral to respectful care, for the continuously increasing numbers of morbidly obese pregnant women. It is preferable to avoid semi- or urgent caesarean deliveries in morbidly obese women after IOL. The outcomes of earlier induction of labour from 39- or 40-weeks' gestation requires investigation. Earlier induction may reduce the numbers of caesarean deliveries for abnormal cardiotocograph during the process.
病态肥胖和延长妊娠与不良分娩和围产儿结局独立相关。我们对其他方面无并发症且 BMI≥40kg/m²的孕妇进行了一项回顾性观察研究，这些孕妇已经足月，计划引产以预防延长妊娠。主要目的是描述分娩结局以及短期母婴不良事件。在纳入的 117 例病例中，有 69 例（59%）在诱导日期前自然分娩，而 48 例（41%）需要引产。在进行引产的 48 例患者中，有 22 例（45.8%）实现了阴道分娩，而自然分娩的有 55 例（79.7%）（ = <.001）。117 例婴儿中，有 22 例（18.8%）体重超过 4000g，其中 13 例经阴道分娩。总的来说，需要引产的病态肥胖足月患者，在需要引产之前自然分娩的阴道分娩率较高。然而，当需要引产时，剖宫产率急剧上升。
影响陈述病态肥胖和延长妊娠与不良分娩和围产儿结局独立相关。引产（IOL）增加了繁忙单位的工作量。这些结果有助于为不断增加的病态肥胖孕妇提供准确的分娩结局咨询，这是尊重护理的重要组成部分。最好避免 IOL 后病态肥胖妇女的半紧急或紧急剖宫产。需要进一步研究 39-40 周妊娠时早期引产的结局。早期引产可能会减少因异常胎心监护图而进行剖宫产的数量。
