scholarly journals Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alexa Eberle ◽  
Nicholas Czuzoj-Shulman ◽  
Laurent Azoulay ◽  
Haim Arie Abenhaim
Keyword(s):  
Propensity Score ◽  
Cesarean Delivery ◽  
Conditional Logistic Regression ◽  
Induction Of Labor ◽  
Maternal Outcomes ◽  
Obese Women ◽  
Increased Risk ◽  
Study Population ◽  
Matched Study ◽  
Death Data

Abstract Objectives To evaluate if induction of labor (IOL) in obese women at 39 weeks of gestation decreases the risk of cesarean delivery (CD). Methods We conducted a retrospective propensity score matched study using the Center for Disease Control’s (CDC’s) Period Linked Birth-Infant Death data. The study population consisted of cephalic singleton births to women with BMI greater or equal to 30.0 kg/m2 who delivered at or beyond 39 weeks between 2013 and 2017. Women with prior CD were excluded. Women who underwent IOL at 39 weeks were propensity score matched 1:5 on the basis of CD risk factors to women who did not undergo IOL at 39 weeks but may have had an IOL at a later gestational age. Conditional logistic regression compared CD rates and maternal outcomes between obese women induced at 39 weeks with those not induced at 39 weeks. Results Our cohort consisted of 197,343 obese women induced at 39 weeks and 986,715 obese women not induced at 39 weeks. Overall, the risk of CD among women who had an IOL at 39 weeks was lower than those without an IOL at 39 weeks, 0.59 (0.58–0.60). The decrease in CD risk was more pronounced in multiparas, 0.47(0.46–0.49) than nulliparas, 0.81(0.79–0.83). When stratified by BMI, the effect of IOL on lowering CD risk was similar across all obesity classes. Aside from an increased risk of instrumental deliveries, morbidities were comparable in both groups. Conclusions IOL at 39 weeks among obese women appears to lower the risk of CD, without compromising maternal outcomes.

Pregnancy Outcomes after Early Amniotomy among Class III Obese Gravidas Undergoing Induction of Labor

2018 ◽  
Vol 36 (05) ◽  
pp. 449-454
Author(s):  
Daniel Pasko ◽  
Kathryn Miller ◽  
Victoria Jauk ◽  
Akila Subramaniam
Keyword(s):  
Cesarean Delivery ◽  
Pregnancy Outcomes ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Obese Women ◽  
Class Iii ◽  
Membrane Rupture ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Class Iii Obesity

Objective We sought to evaluate differences in pregnancy outcomes following early amniotomy in women with class III obesity (body mass index ≥40 kg/m2) undergoing induction of labor. Study Design This is a retrospective cohort study of women with class III obesity undergoing term induction of labor from January 2007 to February 2013. Early amniotomy was defined as artificial membrane rupture at less than 4 cm cervical dilation. The primary outcome was cesarean delivery. Secondary outcomes included length of labor, a maternal morbidity composite, and a neonatal morbidity composite. A subgroup analysis examined the effect of parity. Multivariable logistic regression was used to adjust for covariates. Results Of 285 women meeting inclusion criteria, 107 (37.5%) underwent early amniotomy and 178 (62.5%) underwent late amniotomy. Early amniotomy was associated with cesarean delivery after multivariable adjustments (adjusted odds ratio [aOR], 2.05; 95% confidence interval [CI], 1.21–3.47). There were no significant differences in length of labor or maternal and neonatal morbidity between groups. When stratified by parity, early amniotomy was associated with increased cesarean delivery (aOR, 3.10; 95% CI, 1.47–6.58) only in nulliparous women. Conclusion Early amniotomy among class III obese women, especially nulliparous women, undergoing labor induction may be associated with an increased risk of cesarean delivery.

Assessing Maternal and Fetal Risks Associated with Prolonged Induction of Labor

2018 ◽  
Vol 36 (05) ◽  
pp. 455-459 ◽  
Author(s):  
Jourdan Triebwasser ◽  
Jamie VanArtsdalen ◽  
Emily Kobernik ◽  
Kristian Seiler ◽  
Elizabeth Langen
Keyword(s):  
Propensity Score ◽  
Cesarean Delivery ◽  
Postpartum Hemorrhage ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Neonatal Morbidity ◽  
Induction Of Labor ◽  
Neonatal Outcomes ◽  
Cervical Dilation ◽  
Intensive Care Admission

Objective To assess whether prolonged induction of labor was associated with increased maternal or neonatal morbidity. Study Design We performed a retrospective cohort study of women undergoing induction of labor at a single institution. We included women with singletons ≥ 36 weeks with initial cervical dilation ≤4 cm. Prolonged induction of labor was defined as lasting > 36 hours from the time of initial method to delivery. A 2-to-1 propensity score-matched analysis was performed between women with and those without prolonged induction of labor. Maternal outcomes were cesarean delivery, chorioamnionitis, endometritis, postpartum hemorrhage, severe perineal laceration, and length of postpartum admission. Neonatal outcomes included Apgar scores, umbilical artery pH, and neonatal intensive care admission. Results Among 2,021 women, 407 (20.1%) had a prolonged induction. In unadjusted analyses, prolonged induction of labor was associated with increased cesarean delivery and chorioamnionitis. After 2-to-1 propensity score matching, there were 267 women with prolonged induction and 424 controls. Women with prolonged induction of labor had higher rates of cesarean delivery (35.6 vs. 16%, p < 0.001), chorioamnionitis (14.2 vs. 4.7%, p < 0.001), endometritis (6.4 vs. 1.9%, p = 0.002), and postpartum hemorrhage (18.8 vs. 11.9%, p = 0.008). There were no significant differences in neonatal outcomes. Conclusion Overall length of induction impacts maternal outcome.

Term Elective Induction of Labor and Risk of Cesarean Delivery in Obese Women [326]

2015 ◽  
Vol 125 ◽  
pp. 103S-104S
Author(s):  
Vanessa Rose Lee ◽  
Jonathan Snowden ◽  
Blair G. Darney ◽  
Elliott Kingwill Main ◽  
William M. Gilbert ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Induction Of Labor ◽  
Obese Women ◽  
Elective Induction

881: Term elective induction of labor and risk of cesarean delivery in nulliparous obese women

2015 ◽  
Vol 212 (1) ◽  
pp. S419-S420
Author(s):  
Vanessa Lee ◽  
Blair Darney ◽  
Jonathan Snowden ◽  
Elliott Main ◽  
William Gilbert ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Induction Of Labor ◽  
Obese Women ◽  
Elective Induction

scholarly journals Nonmedically indicated induction in morbidly obese women is not associated with an increased risk of cesarean delivery

2017 ◽  
Vol 217 (4) ◽  
pp. 451.e1-451.e8 ◽  
Author(s):  
Tetsuya Kawakita ◽  
Sara N. Iqbal ◽  
Chun-Chih Huang ◽  
Uma M. Reddy
Keyword(s):  
Cesarean Delivery ◽  
Morbidly Obese ◽  
Obese Women ◽  
Increased Risk

scholarly journals 455Association of interpregnancy interval and preterm births: what does a sibling-matched study indicate?

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Gizachew Tessema ◽  
M Luke Marinovich ◽  
Siri E Håberg ◽  
Mika Gissler ◽  
Jonathan A Mayo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Birth Outcomes ◽  
Meta Analysis ◽  
Conditional Logistic Regression ◽  
Preterm Births ◽  
Adverse Birth Outcomes ◽  
Interpregnancy Interval ◽  
Insufficient Evidence ◽  
Increased Risk ◽  
Matched Study

Abstract Background Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from between-women (unmatched) studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women (sibling-matched) can address this issue. Methods We conducted an international longitudinal study of births from Australia, Finland, Norway, and United States (California) covering over three decades (1980-2017). We included 5,523,914 births to 3,849,737 women, and within each country, we first investigated the associations between IPI and preterm birth (PTB), spontaneous PTB using logistic regression (unmatched analyses). Second, we used conditional logistic regression comparing IPIs in the same women (sibling-matched analyses), with 2,908,907 births to 1,234,730 women having at least two IPIs. Random effects meta-analysis was used to calculate pooled effect estimates. Results Compared to an IPI of 18-23 months, there was insufficient evidence of association between IPI &lt;6 months and overall PTB (adjusted odds ratio (aOR)=1.08, 95%CI 0.99-1.18) but increased odds of spontaneous PTB (aOR=1.38, 95%CI 1.21-1.57). We observed elevated odds of both birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for &lt;12 month and &gt;24 month IPIs. Conclusions We found consistently elevated odds of PTB following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of overall PTB. Key message Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.

scholarly journals A propensity-score matched observational study of remdesivir in patients with COVID-19 and severe kidney disease

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006152021
Author(s):  
Rituvanthikaa Seethapathy ◽  
Sophia Zhao ◽  
Joshua D. Long ◽  
Ian A. Strohbehn ◽  
Meghan E. Sise
Keyword(s):  
Kidney Disease ◽  
Propensity Score ◽  
Propensity Scores ◽  
Altered Mental Status ◽  
Control Group ◽  
Increased Risk ◽  
Kidney Replacement Therapy ◽  
Clinically Significant ◽  
End Stage ◽  
Matched Study

Background: Remdesivir is not currently approved for patients with estimated glomerular filtration rate (eGFR) < 30mL/min/1.73m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods: Retrospective cohort study of patients with COVID-19 hospitalized between May 2020 to January 2021 with eGFR <30 mL/min/1.73m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 - April 30, 2020 prior to Emergency Use Authorization of remdesivir within a large healthcare system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results: The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR <30 mL/min/1.73m2 and 217 COVID-19 controls with eGFR <30 mL/min/1.73m2. The propensity score-matched cohort included 31 remdesivir treated cases and 31 non-remdesivir-treated controls. The mean age was 74.0 (SD: 13.8), 56.6% female, 67.7% white. A total of 25.5% had end-stage kidney disease. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined ≥ 50% increase in creatinine or initiation of kidney replacement therapy) compared to three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusion: In this propensity-score matched study, remdesivir was well tolerated in patients with eGFR < 30 mL/min/1.73m2.

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