475 Comparison between medical and mechanical cervical ripening in obese nulliparous women-A randomized controlled trial

Abstract

Obesity has been associated with adverse maternal and neonatal outcomes. Data regarding the optimal method of induction in this population is limited with contradicting results. In the current study we aimed to compare between medical and mechanical methods of induction in obese pregnant women. A randomized controlled trial conducted from June 2016 to July 2020. Nulliparous women with a pre-pregnancy BMI>30, singleton term pregnancies and a bishop score<5 with an indication for induction of labor were eligible for the study. Exclusion criteria included a previous cesarean section (CS), multiple pregnancy or non-cephalic presentation. Participants were randomized to either mechanical induction with a cervical ripening balloon (CRB) or a 10 mg vaginal Dinoprostone insert. The primary outcome was delivery rate within 24 hours. Secondary outcomes included time to delivery, CS rate, and 2 composites of maternal and neonatal outcomes. A total of 164 women participated in the study, 83 in the CRB group and 81 in the PGE2 group. There was a significant difference in the rate of deliveries within 24 hours, the time to delivery and the rate of need for additional induction between the PGE2 and CRB groups (45% vs. 71%, p=0.017 and 49.3±6.8 hours vs. 23.5±5.9 hours, p=0.003 and 59.2% vs. 14.4%, p<0.0001 respectively). There were no differences in the rate of vaginal delivery or other secondary outcomes (Table 2). CRB leads to expeditious delivery compared to PGE2 in obese nulliparous women without affecting other obstetric outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)