Showing papers on "Labor Complication published in 2012"

Labor analgesia for the obese parturient.

Abstract: Obese parturients present obstetric anesthesia providers with multiple challenges, including increased incidence of maternal coexisting disease, labor complications, and potential for difficult initiation and failure of neuraxial labor analgesia. This focused review discusses these challenges, and suggests potential methods to increase labor analgesia success in this population.

Maternal Obesity and Labor Complications After Induction of Labor in Prolonged Pregnancy

Abstract: The increase in maternal obesity is having a major impact on female reproduction and maternity services in the UK. Obesity in pregnancy has been associated with many adverse outcomes, including greater risk for cesarean section (CS), postpartum hemorrhage, maternal hypertension, and gestational diabetes. Obese women have also been reported to have longer gestations, thus increasing the risks of post-term delivery and induction of labor (IOL). These factors have been associated with increased rates of CS and perinatal and maternal complications. National guidelines recommend that IOL be offered between 41 and 42 weeks’ gestation, as the alternative of conservative management has an even greater chance of perinatal mortality. Few data exists on delivery complications after IOL in obese parturients. Thus, the purpose of this retrospective cohort study was to assess the risk of prolonged pregnancy with high maternal body mass index (BMI) and the risk of delivery complications after IOL in obese versus normal-weight women. Subjects included women with singleton pregnancies, delivered at >24 weeks gestation between January 2004 and December 2008 in a large UK university maternity unit. Primary outcome measures were length of gestation, mode of delivery, and maternal and neonatal complications after IOL for prolonged pregnancy in obese compared with normal-weight parturients. Women were divided into groups based on BMI: r19.9 (underweight); 20 to 24.9 (normal); 25 to 29.9 (overweight); 30 to 34.9 (obese); 35 to 39.9 (very obese); and >40 (morbidly obese). Demographic and obstetric data were obtained from the unit’s Meditech database and labor/delivery records. Maternal variables assessed were age, race, height and weight at booking, parity, smoking status, gestation at delivery, estimated blood loss, second and third-degree tears, and episiotomy. Neonatal variables were sex, birthweight, Apgar scores, cord blood pH, and incidence of dystocia and stillbirth. Statistical analyses included Kruskal-Wallis test, w statistics, and multivariable logistic regression. After exclusions (eg, missing data, elective CS, and IOL at <41wk), 20,559 singleton deliveries were available for analysis of length of gestation by BMI category; 3076 women having IOL for prolonged pregnancies (Z290 days or Z41 weeks) were further analyzed for delivery outcomes after IOL. Increasing maternal BMI was associated with slightly longer gestations, with median gestation in underweight women being 281 days, normal-weight women 283 days, and morbidly obese women 287 days. Prolonged pregnancies occurred in 30.0% of obese women versus 22.3% and 17.1% of normal and underweight groups, respectively. Rates in very obese and morbidly obese women were 32.4% and 39.4%, respectively. Prolonged pregnancy was also associated with older maternal age and white race. Smoking greatly increased the risk of preterm delivery and decreased the rate of prolonged pregnancy. IOL was performed in 24.2% of underweight women, 26.2% of normalweight, 34.4% of obese, 40%, of very obese, and 43.6% of morbidly obese. Obese women had a significantly higher rate of IOL ending in CS compared with those of normal weight: 38.7% versus 23.8% among primiparae; 9.9%, versus 7.9% in multiparae. Rates of PPH, third-degree tear, low cord blood pH, and Apgar scores, and shoulder dystocia were similar among all BMI groups. The rate of fetal macrosomia increased with increasing BMI. The findings of this study showed that higher maternal BMI at booking was associated with an increased risk of prolonged pregnancy, IOL, and CS. However, >60% of obese primiparae and 90% of obese multiparae undergoing IOL for prolonged pregnancy achieved a vaginal delivery with similar labor complications as normal-weight women. The authors concluded that IOL is a reasonable, safe management option for prolonged pregnancy in obese women.