Methods of induction of labor in women with obesity: A secondary analysis of two multicenter randomized controlled trials.

Autor: Croll DMR; Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands., De Vaan MDT; Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.; Department of Health Care Studies, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands., Moes SL; Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands., Bloemenkamp KWM; Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands., Ten Eikelder MLG; Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands., De Heus R; Department of Obstetrics and Gynecology, St. Antonius Hospital, Utrecht, the Netherlands., Jozwiak M; Outpatient Clinic for Gynecology, Vrouwenkliniek Zuidoost, Amsterdam, the Netherlands., Kooiman J; Department of Obstetrics, Division Woman and Baby, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, the Netherlands., Mol BW; Department of Obstetrics and Gynecology, Monash University, Melbourne, Victoria, Australia.; Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK., Verhoeven CJM; Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK.; Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, the Netherlands.; Midwifery Science, AVAG, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands., De Boer MA; Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, the Netherlands.; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Acta obstetricia et gynecologica Scandinavica [Acta Obstet Gynecol Scand] 2024 Mar; Vol. 103 (3), pp. 470-478. Date of Electronic Publication: 2024 Jan 06.
DOI: 10.1111/aogs.14737
Abstrakt: Introduction: Obesity is an increasing public health concern worldwide and can lead to more complications in pregnancy and childbirth. Women with obesity more often require induction of labor for various indications. The aim of this study is to assess which method of induction of labor is safest and most effective in women with obesity.
Material and Methods: This is a secondary analysis of two randomized controlled trials about induction of labor. Women with a term singleton pregnancy in cephalic presentation, an unfavorable cervix, intact membranes and without a previous cesarean section were randomly allocated to cervical priming with a Foley catheter or vaginal prostaglandin-E2-gel (PROBAAT-I) or a Foley catheter or oral misoprostol (PROBAAT-II). The inclusion and exclusion criteria for the studies were identical. Induction methods were compared in women with obesity (body mass index ≥30.0). Main outcomes were cesarean section and postpartum hemorrhage (blood loss >1000 mL).
Results: A total of 2664 women, were included in the trials, 517 of whom were obese: 254 women with obesity received a Foley catheter, 176 oral misoprostol and 87 prostaglandin E2 (PGE2). A cesarean section was performed in 29.1% of women allocated to Foley vs 22.2% in the misoprostol and 23.0% in the PGE2 groups. Comparisons between groups revealed no statistically significant differences: the relative risk [RR] was 1.31 (95% confidence interval [CI] 0.94-1.84) in the Foley vs misoprostol group and 1.27 (95% CI 0.83-1.95) in the Foley vs PGE2 group. The rates of postpartum hemorrhage were comparable (10.6%, 11.4% and 6.9%, respectively; P = 0.512). In women with obesity, more often a switch to another method occurred in the Foley group, (20.1% vs 6.3% in misoprostol vs 1.1% in the PGE2 group; P < 0.001). The risk of a failed Foley placement was higher in women with obesity than in women without obesity (8.3% vs 3.2%; adjusted odds ratio 3.12, 95% CI 1.65-5.90).
Conclusions: In women with obesity we found a nonsignificant trend towards an increased rate of cesarean sections in the group induced with a Foley catheter compared to oral misoprostol; however, the study lacked power for this subgroup analysis. The finding of a higher risk of failed placement of a Foley catheter in women with obesity can be used in shared decision making.
(© 2024 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)
Databáze: MEDLINE
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