Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.

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Publication Type Journal Article
School or College School of Medicine
Department Pediatrics; Obstetrics & Gynecology
Creator Varner, Michael W.
Other Author Hibbard, Judith U.; Gilbert, Sharon; Landon, Mark B.; Hauth, John C.; Leveno, Kenneth J.; Spong, Catherine Y.; Caritis, Steve N.; Harper, Margaret; Wapner, Ronald J.; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; Peaceman, Alan M.; O'Sullivan, Mary J.; Sibai, Baha M.; Langer, Oded; Thorp, John M.; Ramin, Susan M.; Mercer, Brian M.; Gabbe, Steven G.
Title Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.
Date 2006-07
Description OBJECTIVE: Assess effects of body mass index (BMI) on trial of labor after previous cesarean delivery and determine whether morbidly obese women have greater maternal and perinatal morbidity with trial of labor compared with elective repeat cesarean delivery. METHODS: Secondary analysis from a prospective observational study included all term singletons undergoing trial of labor after previous cesarean delivery. Body mass index groups were as follows: normal 18.5-24.9, overweight 25.0-29.9, obese 30.0-39.9, morbidly obese 40.0 kg/m2 or greater, and were compared for failure and maternal and neonatal morbidities. The morbidly obese trial of labor and elective repeat cesarean delivery were compared for maternal and neonatal morbidities. Multivariable logistic regression analysis controlled for confounding variables. RESULTS: There were 14,142 trial of labor participants and 14,304 elective repeat cesarean delivery participants. Increasing BMI was directly associated with failed trial of labor after previous cesarean delivery: from 15.2% in normal weight (1,344) to 39.3% in morbidly obese (1,638), with combined risk of rupture/dehiscence increasing from 0.9% to 2.1% in morbidly obese women. Among morbidly obese women, trial of labor carried greater than five-fold risk of uterine rupture/dehiscence (2.1% versus 0.4%), almost a two-fold increase in composite maternal morbidity (7.2% versus 3.8%) and five-fold risk of neonatal injury (1.1% versus 0.2%) (fractures, brachial plexus injuries, and lacerations), but no neonatal encephalopathy. Morbidly obese women failing a trial of labor had six-fold greater composite maternal morbidity than those undergoing a successful trial of labor (14.2% versus 2.6%). CONCLUSION: Body mass index correlates with outcomes in trial of labor after previous cesarean delivery. Morbidly obese women undergoing a trial of labor were at increased risk for failure. Increased BMI was associated with greater composite morbidity and neonatal injury compared with elective repeat cesarean delivery, but absolute morbidities were small. Increased risks should be considered before trial of labor after previous cesarean delivery. LEVEL OF EVIDENCE: II-2.
Type Text
Publisher Lippincott, Williams & Wilkins
Volume 108
Issue 1
First Page 125
Last Page 133
Subject Pregnancy Outcome; Obesity; Repeat Cesarean Section; Body Mass Index
Subject MESH Vaginal Birth after Cesarean; Pregnancy ComplicatBody Mass Indexions; Trial of Labor
Language eng
Bibliographic Citation Hibbard JU, Gilbert S, Landon MB, Hauth JC, Leveno KJ, Spong CY, Varner MW, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM, Gabbe SG; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol. 2006 Jul;108(1):125-33. Retrieved on May 25th 2007 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed
Rights Management Copyright © Wolters Kluwer, Obstetrics and Gynecology, 108, 125-33, 2006
Format Medium application/pdf
Identifier ir-main,1592
ARK ark:/87278/s61n8jbh
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2021-05-06
ID 703627
Reference URL https://collections.lib.utah.edu/ark:/87278/s61n8jbh
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