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BJOG. 2011 Mar;118(4):480-7. doi: 10.1111/j.1471-0528.2010.02832.x. Epub 2011 Jan 18.

Planned vaginal delivery or planned caesarean delivery in women with extreme obesity.

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1
National Perinatal Epidemiology Unit, University of Oxford, UK.

Abstract

OBJECTIVE:

To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)).

DESIGN:

A national cohort study using the UK Obstetric Surveillance System (UKOSS).

SETTING:

All hospitals with consultant-led maternity units in the UK.

POPULATION:

Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008.

METHODS:

Prospective cohort identification through UKOSS routine monthly mailings.

MAIN OUTCOME MEASURES:

Anaesthetic, postnatal and neonatal complication rates.

RESULTS:

After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications.

CONCLUSIONS:

This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.

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