(768) Outcomes in Women with Body Mass Index 60 kg/m2: Planned Cesarean Versus Attempted Vaginal Delivery

To examine maternal and neonatal outcomes in women with body mass index (BMI) 60 kg/m² or greater who attempted vaginal delivery versus those who had planned cesarean delivery.

Study Design:

This was a multicenter retrospective study of women with BMI 60 kg/m² or greater who delivered at term from 2009-2020. Both nulliparous and multiparous patients were included in the study. We excluded patients with previous cesarean delivery, placenta previa or accreta, congenital anomaly, and stillbirth. The primary outcome was a composite of maternal outcomes including transfusion, postpartum hemorrhage, intensive care unit admission (ICU), venous thromboembolism (VTE), postpartum emergency department visit, and readmission. We also examined a composite neonatal outcome including neonatal ICU admission (NICU), use of continuous positive airway pressure (CPAP), mechanical ventilation, transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), sepsis, or death. Adjusted odds ratios (aOR) with 95% confidence interval (95% CI) were calculated, controlling for gestational age at delivery and BMI (planned cesarean as a referent).

Results:

Of 225 women, 181 (80.4%) attempted a vaginal delivery and 44 (19.6%) had a planned cesarean delivery. Women with a planned cesarean delivery had a higher BMI at the time of delivery and were more likely to deliver at an earlier gestational age (Table 1). Of women who attempted a vaginal delivery, 49.7%  required a cesarean delivery. There were no differences in maternal composite outcomes (35.4% vs. 45.5%; aOR 1.25; 95% CI 0.62-2.51) or neonatal composite outcomes (19.3% v.s 22.7%; aOR 0.96; 95% CI 0.42-2.22) between those who attempted a vaginal delivery and those who had a planned cesarean delivery (Table 2).

Conclusion:

While women with BMI 60 kg/m² or greater are at higher risk for cesarean delivery after attempting vaginal delivery, there were no differences in maternal and neonatal between those with an attempted vaginal delivery and those with a planned cesarean section. It is reasonable for women with BMI 60 kg/m² or greater to attempt vaginal delivery.