Planned vaginal delivery or planned caesarean delivery in women with extreme obesity

BJOG. 2011 Mar;118(4):480-7. doi: 10.1111/j.1471-0528.2010.02832.x. Epub 2011 Jan 18.

Abstract

Objective: To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)).

Design: A national cohort study using the UK Obstetric Surveillance System (UKOSS).

Setting: All hospitals with consultant-led maternity units in the UK.

Population: Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008.

Methods: Prospective cohort identification through UKOSS routine monthly mailings.

Main outcome measures: Anaesthetic, postnatal and neonatal complication rates.

Results: After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications.

Conclusions: This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cesarean Section
  • Delivery, Obstetric*
  • Female
  • Humans
  • Obesity / therapy*
  • Patient Care Planning
  • Pregnancy
  • Pregnancy Complications / therapy*
  • Pregnancy Outcome
  • Prenatal Care / methods
  • Prospective Studies