Labor In Obese Women Research Articles

Frequency of Successful Vaginal Delivery after Induction of Labour in Obese Pregnant Women Presenting at Tertiary Care Hospital Peshawar

Introduction: The incidence of induction of labour is 20% of all deliveries and is considered as the most common techniques in modern obstetrics. But both medically indicated and elective inductions are thought to increase the risk of instrumental and cesarean deliveries. Objective: Aim of this study was to determine the frequency of successful vaginal delivery after induction of labour in obese women. Methodology: This study was descriptive study carried out at Gynecology and Obstetrics Department, Hayatabad Medical Complex, Peshawar. The duration of study was Six months (from 1/2/2021 to 1/8/2021). Detail history, clinical examination, routine investigation were performed for the confirmation of obese pregnant women. All the data i.e. age, gestational age, parity, gravidity, number of induction, duration of labour, previous history of C section was recorded in pre design performa. All the recorded information on performa was entered in statistical software SPSS ver 23. Results: Our study shows that among 149 patients mean maternal age was 29 years with standard deviation ± 5.91. Among 149 patients successful vaginal delivery was observed in 86(58%) patients while 63(42%) patients were observed with un-successful vaginal delivery. Conclusion: Our study concludes that the frequency of successful vaginal delivery was 58% after induction of labour in obese pregnant women presenting at tertiary care hospital Peshawar. Keywords: Successful vaginal delivery, Induction of labour, obese pregnant women

Induction of labor in obese women

Induction of labor in obese women

High Dose Versus Low Dose Oxytocin for Augmentation of Delayed Labour in Obese Women: A Randomized Clinical Trial

High Dose Versus Low Dose Oxytocin for Augmentation of Delayed Labour in Obese Women: A Randomized Clinical Trial

Clinical features of labor and morphological aspects of the myometrium receptor profile in obese women

BACKGROUND: Obesity is currently considered as one of the most significant social chronic diseases. It has been proven that obese pregnant women are more likely than women with normal body weight to experience complications of pregnancy and labor. The most frequent complications of labor in obese women are weakness and discoordination, which are probably associated with a decrease in the sensitivity of the myometrium to oxytocin, due to suppression of oxytocin receptor expression.
 AIM: The aim of this study was to explore the clinical features of labor and morphological aspects of the myometrium receptor apparatus in obese women.
 MATERIALS AND METHODS: We performed a prospective assessment of labor activity in women with obesity, with a combination of obesity and gestational diabetes mellitus and in healthy women. We also conducted a morphological study of myometrium biopsies obtained during cesarean section.
 RESULTS: Obese patients are more likely to experience various complications of pregnancy and labor, which is the reason for the higher frequency of operative delivery. Patients with obesity showed lower expression of oxytocin receptors in the lower segment of the uterus, which, apparently, is the cause of abnormal contractility of the myometrium during labor and the lack of effect from drug correction of this condition.
 CONCLUSIONS: The presence of obesity in women before pregnancy contributes to frequent complications of pregnancy and labor, abnormal uterine contractility related to the decreased oxytocin receptor expression, and a high incidence of surgical delivery.

Modality of Induction of Labor in Obese Women at Term (MODOBAT)

Modality of Induction of Labor in Obese Women at Term (MODOBAT)

ОСОБЛИВОСТІ ПЕРЕБІГУ ПОЛОГІВ У ВАГІТНИХ З ОЖИРІННЯМ

Ожиріння вагітних є глобальною проблемою сьогодення. Актуальність проблеми ожиріння вагітних полягає в наявності численних ускладнень під час вагітності, які можуть вплинути на перебіг пологів, стан матері та плода, обумовити проведення оперативного розродження, а також післяпологові ускладнення. Метою даного дослідження було вивчення особливостей перебігу пологів у вагітних з ожирінням. Методика проведення дослідження полягала в ретроспективному аналізі пологів у 100 вагітних з ожирінням, які були поділені на 3 підгрупи в залежності від ступеня ожиріння (І, ІІ, ІІІ), який визначався за ІМТ на момент взяття на облік з приводу вагітності. В порівняльному аспекті проаналізовано перебіг пологів у 100 вагітних без ожиріння.За даними медичної документації в аналіз входила оцінка терміну вагітності (доношена, з тенденцією до переношування, переношена) і пологів (своєчасні, передчасні, запізнілі) та ступінь зрілості шийки матки за шкалою Бішопа (зріла, недостатньо зріла, незріла), характер початку пологів (самостійний, індукований) та їх перебіг (фізіологічні, патологічні). Статистичний аналіз результатів був проведений у пакеті EZR v.1.35 (R statistical software version 3.4.3, R Foundation for Statistical Computing, Vienna, Austria) (Kanda, 2013).
 Результати. Порівняльна оцінка результатів пологів у жінок 1 та 2 груп показала, що своєчасні пологи становлять переважну більшість в обох групах ( відповідно в 1 групі – 80,0%, а в 2 групі – 91,0%.). Частота несвоєчасних пологів вище у жінок з ожирінням: передчасні пологи в 1,7 разів, а запізнілі в 4 рази. У вагітних з ожирінням недоношена вагітність (˂ 37 тижнів на початок пологів) відмічена у 12,0% проти 7,0% серед жінок 2 групи. У пацієнток 1 групи доношена вагітність мала місце в 56,0% випадків, з тенденцією до переношування – в 24,0%, в той же час у вагітних 2 групи доношена вагітність спостерігалась у 85,0% жінок, а з тенденцією до переношування – у 6,0%. Серед пацієнток з доношеною вагітністю «зріла» шийка матки відмічена у значного відсотка жінок як 1 групи (70,0%), так і 2 групи (94,0%) з переважанням серед вагітних без ожиріння. Аналіз результатів зрілості шийки матки в підгрупах залежно від ступеня ожиріння показав, що 68,4% вагітних з І та ІІ ступенем ожиріння при надходженні в стаціонар мали «зрілу» шийку матки, відмінність від контрольної групи була статистично значима, p<0,05. У пацієнток з ІІІ ступенем ожиріння порівняно з 2 групою частіше зустрічалась «незріла» або «недостатньо зріла» шийка матки, становлячі відповідно 25% та 6% (p<0,001), що потребувало проведення підготовки (дозрівання) шийки матки з наступною індукцією пологів.
 В цілому, у жінок 1 групи з доношеною вагітністю самостійним був початок пологів у 56,0%, проти 86,0 % у пацієнток 2 групи та індукованим у 10,0% проти 4,0% у вагітних 2 групи. Серед вагітних з тенденцією до переношування самостійним був початок пологів у 15,0% проти 3,0% у пацієнток 2 групи та індукованими у 6,0% проти 2,0% у вагітних 2 групи. Оперативне розродження частіше мало місце у вагітних з ожирінням (33,0%) порівнянно з вагітними без ожиріння (10,0%) В цілому, фізіологічні пологи відбулись у жінок 1 групи у 77,0%, патологічні – у 33,0%. В 2 групі відповідно фізіологічні пологи мали місце в 90,0%, патологічні – в 10,0%.
 Висновки Пологи у вагітних з ожирінням мають певні особливості, які обумовлені зміною структури пологів за терміном вагітності, в якому вони настають, за терміном пологів, в якому вони відбуваються, ступінню зрілості шийки матки, необхідністю проведення преіндукції та індукції пологів. Встановлені зміни залежать від ступеня ожиріння і потребують своєчасної оцінки та прогнозу для оптимального вибору тактики ведення.

Induction of labour with sequential double-balloon catheter and oral misoprostol versus oral misoprostol alone in obese women

ObjectiveTo evaluate the efficacy of induction of labour in obese women using sequential double-balloon catheter and oral misoprostol in comparison with oral misoprostol alone.Study designIn this cohort study, 400 pregnant women with BMI higher than 35 kg/m2 undergoing labour induction at term were included. Induction of labour with a double-balloon catheter and, if necessary, sequential oral misoprostol (n = 216) was compared to oral misoprostol alone (n = 184). The primary outcome measure was the caesarean section rate. Secondary outcome parameters were, among others, the induction-to-delivery-interval, the rate of vaginal delivery within 24 and 48 h as well as fetal outcome parameters.ResultsThe caesarean section rate was significantly lower in the group with sequential use of double-balloon catheter and oral misoprostol (27.6% versus 37.5%, p = 0.0345). After stratification for parity this reduction was seen especially in nulliparous (38.6% versus 56.9%, p = 0.0039). The rate of abnormal CTG was significantly lower as well (19.9% versus 30.4%, p = 0.0150), particularly in nulliparous (25.9% versus 40.4%, p = 0.0138). Uni- and multivariable analyzes showed that the caesarean section rate was significantly influenced by the method of induction of labour (p = 0.0026), parity (p < 0.0001) and Bishop score (p = 0.0425).ConclusionIn obese women, induction of labour with sequential use of double-balloon catheter and oral misoprostol is associated with significantly more normal vaginal deliveries and less caesarean sections.

Maternal plasma leptin levels in relation to the duration of the active phase of labor.

Obese women have increased leptin levels and longer duration of labor compared with normal-weight women. Leptin has an inhibitory effect on myometrial contractility in vitro. Our purpose was to examine whether maternal leptin levels in active labor were associated with the duration of the active phase of labor. This prospective cohort study included 914 women. Maternal blood samples were collected in active labor. The plasma-leptin concentration was obtained using a direct sandwich-based ELISA. Bivariate and multiple linear regression analyses were used to study the association between leptin levels and the duration of labor. A 1ng/mL increase in maternal plasma leptin was associated with a 0.015hour increase in duration of labor (P<.007). This association was not statistically significant in the adjusted analyses nor when analyzing nulliparous and multiparous women separately. In women with spontaneous labor (n=766) leptin levels were not associated with an increase in duration of labor in the adjusted analyses. There was no significant association between leptin levels and duration of the active phase of labor. Leptin in vivo might display a similar dose-response effect on myometrial contractility as demonstrated in in vitro studies. Future studies need to explore the association between leptin levels and time in labor in obese women with high leptin levels to evaluate a possible dose-response effect.

Induction of Labor in Obese Women -What Should We Know?

Induction of Labor in Obese Women -What Should We Know?

Parturition dysfunction in obesity: time to target the pathobiology.

Over a third of women of childbearing age in the United States are obese, and during pregnancy they are at increased risk for delayed labor onset and slow labor progress that often results in unplanned cesarean delivery. The biology behind this dysfunctional parturition is not well understood. Studies of obesity-induced changes in parturition physiology may facilitate approaches to optimize labor in obese women. In this review, we summarize known and proposed biologic effects of obesity on labor preparation, contraction/synchronization, and endurance, drawing on both clinical observation and experimental data. We present evidence from human and animal studies of interactions between obesity and parturition signaling in all elements of the birth process, including: delayed cervical ripening, prostaglandin insensitivity, amniotic membrane strengthening, decreased myometrial oxytocin receptor expression, decreased myocyte action potential initiation and contractility, decreased myocyte gap junction formation, and impaired myocyte neutralization of reactive oxygen species. We found convincing clinical data on the effect of obesity on labor initiation and successful delivery, but few studies on the underlying pathobiology. We suggest research opportunities and therapeutic interventions based on plausible biologic mechanisms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0129-6) contains supplementary material, which is available to authorized users.

Influence of obesity on route of delivery in a population of African descent in Martinique.

To determine whether obesity is an independent risk factor for cesarean delivery in Martinique. A retrospective study was performed using data for deliveries that occurred at the University Hospital of Fort de France between January and September 2010. Women were divided into four groups on the basis of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters; < 25 [group 1], 25-29 [group 2], 30-39 [group 3], and ≥ 40 [group 4]). Independent risk factors for cesarean delivery were identified through multivariate analysis. Overall, 1286 women were included. Mean weight gain was lower in groups 2 (9.9 kg, 95% CI 9.2-10.7), 3 (5.7 kg, 4.7-6.7), and 4 (1.0 kg,-1.5 to 3.5), than in group 1 (12.3 kg, 11.9-12.7; P < 0.001 for all). In univariate analysis, cesarean deliveries were more frequent among nulliparous women in group 2 (P = 0.007) and group 3 (P = 0.053) than among those in group 1. In multivariate analysis, BMI was not associated with cesarean delivery (BMI 25-29: adjusted odds ratio 0.64, 95% CI 0.33-1.25; BMI ≥ 30: 0.61, 0.29-1.39). Obesity was not an independent risk factor for cesarean delivery. Weight control and a positive attitude towards trial of labor in obese women could have led to the findings.

The effects of methyl palmitate, a putative regulator from perivascular fat, on the contractility of pregnant human myometrium

AimsMethyl palmitate is thought to cause relaxation in vascular smooth muscle by opening voltage-activated potassium channels. We have tested the hypothesis that methyl palmitate, a putative regulator from perivascular fat, is an inhibitor of the contractility of human pregnant myometrium and that its effects might partially explain the higher incidence of dysfunctional labor in obese women compared to those with normal body mass indices. Main methodsStrips of myometrium obtained with informed consent from women undergoing elective cesarean section at term were mounted in organ baths. Strips stimulated with oxytocin (1nM) or KCl (30mM) were exposed to cumulatively increasing concentrations of methyl palmitate up to 10μM. Similar strips were exposed to cumulative addition of the potassium channel blockers 4-aminopyridine and tetraethylammonium. The contractility of the strips was monitored and analyzed using conventional methods. Key findingsMethyl palmitate failed to inhibit oxytocin- or KCl-induced contractions over the concentration range tested. In fact, it exerted a slight excitatory effect in the presence of KCl, though not in the presence of oxytocin. The contractility of naïve strips was unaltered by exposure to 1μM methyl palmitate. Both 4-aminopyridine and tetraethylammonium produced concentration-dependent contractions of human pregnant myometrium providing pharmacological evidence for the presence of voltage-activated potassium channels in this preparation. SignificanceOur findings do not support the hypothesis that methyl palmitate is an inhibitor of human pregnant myometrial contractility. Alternate hypotheses must be pursued to explain the higher incidence of dysfunctional labor in obese women.

Induction of Labor in Obese Women at 39 Weeks Provides Optimal Delivery and Cost Outcomes

Planning a vaginal delivery provides optimal delivery and cost outcomes, according to a study that used a computational model to estimate the effect of induction of labor compared to expectant management of term pregnancies in obese women. They found that induction at 39 weeks of gestation minimized cesarean deliveries, stillbirths, and delivery-related health care costs.

Maternal body mass index and duration of labor

ObjectiveTo evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor. Study designHistorical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight. ResultsThe median duration of labor was significantly longer in obese women (class I obesity (BMI 30–34.9)=9.1h, class II obesity (BMI 35–39.9)=9.2h and class III obesity (BMI>40)=9.8h) compared to normal-weight women (BMI 18.5–24.9)=8.8h (p<0.001). The risk of labor lasting more than 12h increased with increasing maternal BMI: OR 1.04 (1.01–1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12h or emergency cesarean section within 12h, compared to vaginal deliveries within 12h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45h compared to normal weight women, 0.55h (p<0.001). ConclusionIn nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.

Women with high BMI: Should they be managed differently due to antagonising action of leptin in labour?

Leptin – a protein hormone is synthesised in the adipose tissue in humans. Its level therefore should be directly proportional to the amount of adipose tissue in the body. There is evidence that leptin may be responsible for various complications in obese and morbidly obese women in labour by its effect on the myometrium causing uterine smooth muscle relaxation (causes less Ca2+ flux in myometrium). By doing this, we believe it opposes oxytocin effect on the myometrium which in fact promotes uterine smooth muscle contractions (causes more Ca2+ flux in myometrium). The opposing action of these two hormone may contribute to the dysfunctional labour process, prolonged first stage of labour, increase in operative vaginal delivery in second stage of labour and increase in caesarean section rate both in first and second stage of labour in obese women. Also, there is increased incidence of postdated pregnancy, induction of labour and atonic postpartum haemorrhage in obese and morbidly obese women. Does this mean labour should be managed differently in women with high BMI?

Obesity in pregnancy: Altered onset and progression of labour

Backgroundthe incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. Objectiveto review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. Methodsa literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. Findingsthe combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. Conclusionsanalysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. Implications for practicean adapted clinical approach is suggested in these patients.

Leptin – A tocolytic agent for the future?

Leptin - a protein hormone is synthesised in the adipose tissue in humans. Its level therefore should be directly proportional to the amount of adipose tissue in the body. When biopsies of human myometrium from obese women were exposed to leptin, it showed a cumulative inhibitory effect on spontaneous as well as induced contractions. This lead to the proposed theory that leptin may be the cause of dysfunctional labour in obese women leading to increased caesarean section rates. There is an increased rate of post-dated pregnancies in obese women when compared to normal weight women with a consequent increased induction rate in women with a raised body mass index (BMI). Likewise there a decrease in the rate of spontaneous preterm delivery in obese women. These findings suggest that leptin inhibits uterine contractions in these women and this effect could be considered a tocolytic effect on uterine muscle. So could this hormone (leptin) be used as a tocolytic agent for threatened preterm labour in the future?