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

Judith U. Hibbard, Sharon Gilbert, Mark B. Landon, John C. Hauth, Kenneth J. Leveno, Catherine Y. Spong, Michael W. Varner, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. MercerSteven G. Gabbe

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

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/m 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.

Original languageEnglish
Pages (from-to)125-133
Number of pages9
JournalObstetrics and Gynecology
Volume108
Issue number1
DOIs
StatePublished - Jul 1 2006
Externally publishedYes

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Trial of Labor
Morbid Obesity
Morbidity
Body Mass Index
Mothers
Arm Injuries
Uterine Rupture
Confounding Factors (Epidemiology)
Brachial Plexus
Lacerations
Wounds and Injuries
Brain Diseases
Observational Studies

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Hibbard, J. U., Gilbert, S., Landon, M. B., Hauth, J. C., Leveno, K. J., Spong, C. Y., ... Gabbe, S. G. (2006). Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstetrics and Gynecology, 108(1), 125-133. https://doi.org/10.1080/14786430500313820

Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. / Hibbard, Judith U.; Gilbert, Sharon; Landon, Mark B.; Hauth, John C.; Leveno, Kenneth J.; Spong, Catherine Y.; Varner, Michael W.; 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.

In: Obstetrics and Gynecology, Vol. 108, No. 1, 01.07.2006, p. 125-133.

Research output: Contribution to journalArticle

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 2006, 'Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery', Obstetrics and Gynecology, vol. 108, no. 1, pp. 125-133. https://doi.org/10.1080/14786430500313820
Hibbard, Judith U. ; Gilbert, Sharon ; Landon, Mark B. ; Hauth, John C. ; Leveno, Kenneth J. ; Spong, Catherine Y. ; Varner, Michael W. ; 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. / Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. In: Obstetrics and Gynecology. 2006 ; Vol. 108, No. 1. pp. 125-133.
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author = "Hibbard, {Judith U.} and Sharon Gilbert and Landon, {Mark B.} and Hauth, {John C.} and Leveno, {Kenneth J.} and Spong, {Catherine Y.} and Varner, {Michael W.} and Caritis, {Steve N.} and Margaret Harper and Wapner, {Ronald J.} and Yoram Sorokin and Menachem Miodovnik and Marshall Carpenter and Peaceman, {Alan M.} and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Oded Langer and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.} and Gabbe, {Steven G.}",
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T1 - Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery

AU - Hibbard, Judith U.

AU - Gilbert, Sharon

AU - Landon, Mark B.

AU - Hauth, John C.

AU - Leveno, Kenneth J.

AU - Spong, Catherine Y.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Harper, Margaret

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Miodovnik, Menachem

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Langer, Oded

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

AU - Gabbe, Steven G.

PY - 2006/7/1

Y1 - 2006/7/1

N2 - 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/m 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.

AB - 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/m 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.

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