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Trial of labor versus primary cesarean delivery in women with superobesity
Abstract Number: O1-02
Abstract Type: Original Research
OBJECTIVE: Delivery of superobese women (BMI≥50) presents specific challenges regardless of whether a trial of labor (TOL) or plan a primary cesarean delivery (CD) is undertaken. It is unclear whether either choice alters maternal or neonatal outcomes. This study examines maternal and neonatal outcomes among women with superobesity who undergo a TOL versus a primary CD.
METHODS: This is a retrospective cohort study of all singleton deliveries ≥36 weeks’ gestation in the State of California between 2007-2011. Data were extracted from maternal discharge data linked to infant birth certificate records. Included were all women with a body mass index (BMI) ≥50. Excluded were women undergoing a trial of labor after cesarean (TOLAC) or a repeat CD. The primary outcome was severe maternal mortality or death (SMMD). Secondary outcomes included composite neonatal morbidity or death and the individual components of the composites.
RESULTS: There were 3990 (0.3%) women with superobesity who delivered a single fetus at ≥36 weeks. The total CD rate for this group was 59%.1279 (32%) women underwent a repeat CD and 18 (0.9%) underwent a TOLAC leaving 2683 in the final cohort. 71% underwent a TOL and 29% a primary CD. Women undergoing a TOL were less likely to be nulliparous or have HTN or diabetes. Compared to primary CD, women undergoing a TOL had a reduced risk of SMMD (Table 1) however this was not significant after adjusting for parity and HTN (aOR 0.45, 95% CI 0.26-0.87). There were no differences in composite neonatal morbidity. Women who required a CD after a TOL were at increased risk of SMMD compared to women undergoing vaginal delivery (1.7% vs 0.4%, RR 4.7, 95% CI 1.5-15.4), however there was no difference in SMMD compared to women with primary CD (1.7% vs 1.4%, RR 1.22, 95% CI 0.43-3.50). A successful TOL was associated positively with parity and negatively with maternal age and hypertensive disorders.
CONCLUSION: Among women with superobesity, a TOL and primary CD have similar associated morbidities. Primary CD does not appear to reduce these morbidities.