This podcast provides a nice description of the retrospective cohort study performed by Dr. Palatnik and colleagues.
Few studies have been performed to evaluate elective induction of labor in the obese population, however those that have been performed have conflicting results. Dr. Palatnik performed a retrospective cohort study from the Consortium on Safe Labor comparing obese women with a singleton gestation who underwent elective induction at >39 weeks versus expectant management.
Their outcomes of interest includes cesarean section rate (primary outcomes), and adverse maternal and neonatal outcomes (including 3rd/4th degree laceration, postpartum hemorrhage, blood transfusion, endometritis, would infection, apgar score <7 at 5 minutes, macrosomia, presence of meconium, ICU admission and perinatal death at 39, 40 and 41 weeks), which were compared between the groups of elective induction and expectant management groups during the gestational age time frames – 39, 40, 41 weeks. Their statistical methods included univariable and multivariable analysis.
They found that women undergoing induction of labor differed in several ways from the expectant management group – they were more likely to be older, white and married and had more favorable simplified bishops score. When reviewing the primary outcome, both nulliparous and multiparous women undergoing IOL were less likely to have cesarean. Macrosomia was also noted to be reduced in nulliparous and multiparous women undergoing induction of labor at 39 weeks.
The authors concluded that in obese women, an elective induction of labor when compared to expectant management, was associated with decreased cesarean delivery rates and improved maternal and neonatal outcomes. They ended with saying further prospective studies will need to be performed to confirm these results.