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Brien C, Bel S, Boudier E, Deruelle P. [Caesarean risk factors during labor for a class III obese nulliparous]. ACTA ACUST UNITED AC 2020; 49:517-521. [PMID: 33045395 DOI: 10.1016/j.gofs.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Obesity is a well-known caesarean and obstetrical risk factor. However, the number of obese nulliparous women is increasing worldwide, creating an urgent need for research into the impact of obesity on the mode of delivery. Our objective was to identify caesarean risk factors in obese nulliparous women with a BMI (body mass index) greater than 40kg/m2. METHODS A literature review was conducted on PubMed; including articles published between 2009 and 2019 in French and English, on caesarean risk during labor among class III obese nulliparous women. RESULTS One prospective study, and 6 retrospective analyses were included. Their results suggest that the rate of caesarean delivery increases with the BMI. Maternal age, particularly after 35 years, as well as induced labor and the use of oxytocin during labor, were positively associated with cesarean delivery. Moreover, maternal BMI was linked to an increased risk of non-elective caesarean section due to non-reassuring fetal heart tracing. CONCLUSION Extreme BMI, age, induced labor and oxytocin use are associated with caesarean delivery in nulliparous women with BMI≥40kg/m2. Further research are needed to estimate the best candidates for elective cesarean delivery.
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Affiliation(s)
- C Brien
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France.
| | - S Bel
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - E Boudier
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
| | - P Deruelle
- Pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, Strasbourg, France
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Coste Mazeau P, Hessas M, Martin R, Eyraud JL, Margueritte F, Aubard Y, Sallee C, Sire F, Gauthier T. Is there an interest in repeating the vaginal administration of dinoprostone (Propess®), to promote induction of labor of pregnant women at term? (RE-DINO): study protocol for a randomized controlled trial. Trials 2020; 21:51. [PMID: 31915047 PMCID: PMC6950885 DOI: 10.1186/s13063-019-3985-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 12/11/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Labor is induced in over 20% of women in France. Prostaglandins, especially intravaginal dinoprostone (Propess®), are widely used to initiate cervical ripening. If labor does not start within 24 h, there is uncertainty about whether to administer a second dinoprostone pessary or to use oxytocin to induce labor in order to achieve a vaginal delivery. METHODS RE-DINO is a prospective, open-label, multicenter, randomized superiority trial with two parallel arms running in six French hospitals. A total of 360 patients ≥ 18 years of age at > 37 weeks of gestation who exhibit unfavorable cervical conditions (Bishop score < 6) 24 h after placement of the first Propess®, with fetuses in cephalic presentation, will be included. Patients with premature membrane rupture, uterine scars, or multiple pregnancies will be excluded. Our principal objective is to determine whether placement of a second Propess® (followed by oxytocin [Syntocinon®], if necessary) in women for whom the first Propess® failed to induce cervical ripening increases the vaginal delivery rate compared to direct oxytocin injection. The vaginal delivery rate is therefore the primary outcome. The secondary outcomes are the induction failure rates and maternofetal morbidity and mortality. DISCUSSION This study may help in determining the optimal way to induce labor after failure of a first Propess®, an unresolved problem to date. This trial explores the effectiveness and safety of placing a second Propess® and may contribute to development of an obstetric consensus. TRIAL REGISTRATION Registered on 2 September 2016 at clinicaltrials.gov (identification number NCT02888041).
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Affiliation(s)
- P Coste Mazeau
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France.
| | - M Hessas
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - R Martin
- Clinical Investigation Center, CHRU Limoges, 2 Avenue Dominique Larrey, 87000, Limoges, France
| | - J-L Eyraud
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - F Margueritte
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - Y Aubard
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - C Sallee
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - F Sire
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
| | - T Gauthier
- Department of Gynaecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospitals, 8 Avenue Dominique Larrey, 87000, Limoges, France
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Does a body mass index greater than 25 kg/m 2 increase maternal and neonatal morbidity? A French historical cohort study. J Gynecol Obstet Hum Reprod 2017; 46:601-608. [DOI: 10.1016/j.jogoh.2017.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 11/18/2022]
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Garabedian C, Servan-Schreiber E, Rivière O, Vendittelli F, Deruelle P. Obésité maternelle et grossesse : évolution de la prévalence et du lieu d’accouchement à partir des données AUDIPOG. ACTA ACUST UNITED AC 2016; 45:353-9. [PMID: 26139035 DOI: 10.1016/j.jgyn.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/16/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022]
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