The Effect of Maternal Obesity on Oxytocin Requirements to Achieve Vaginal Delivery

Abstract Objective Our objective was to determine if obese women are more likely to require oxytocin rates &gt; 20 mU/min to achieve vaginal delivery, compared with normal weight women. Study Design This is a retrospective cohort study of deliveries at the MedStar Washington Hospital Center and MedStar Georgetown University Hospital. Results There were 4,284 births included in the analysis. Thirty-three per cent of deliveries were among women classified as overweight (body mass index [BMI] 25–29.9 kg/m2) and 58% were among women classified as obese (BMI &gt;30.0 kg/m2), 12% were classified as class III obesity (BMI &gt;40 kg/m2). Overall 110 (2.6%) women required an oxytocin rate of &gt;20 mU/min. Doses of oxytocin &gt;20 mU/min for women in the overweight, class I obesity, and class II obesity groups were 2.6, 1.9, and 1.6%, respectively. Deliveries among women with class III obesity had a significantly longer duration of oxytocin exposure (10.7 hours) compared with the normal weight group (8.2 hours, p &lt; 0.001), and had a higher maximum rate of oxytocin compared (10 mU/min) to normal weight women (8 mU/min, p &lt; 0.001). Conclusion Obese women are more likely to require oxytocin rates more than 20 mU/min, higher doses of oxytocin, and greater duration of oxytocin exposure to achieve a vaginal delivery.</jats:p

Activity restriction and risk of preterm delivery

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Purpose: We sought to determine whether activity restriction (AR) in a cohort of women at high risk for preterm delivery is associated with the risk of preterm delivery. Materials and methods: This is a secondary analysis of the Maternal-Fetal Medicine Units MFMU’s Preterm Prediction Study; a multicenter prospective cohort study designed to identify risk factors of preterm birth (PTB). The study group consisted of women with a singleton gestation that at their first study visit (23–24 weeks) had at least one of the following criteria: patient reported contractions, severe back pain, a cervical length \u3c15 \u3emm, spotting, protruding membranes, or positive fetal fibronectin. Women were assessed for AR at a 27- to 29-week study visit. Associations between AR and preterm delivery (\u3c37 \u3eweeks) were examined through logistic regression models before and after adjustment for confounders. Results: Of the 1086 women that met the inclusion criteria, 16.5% (n = 179) delivered preterm. In this cohort, 9.7% (n = 105) of women were recommended AR, with 37.1% (n = 39) having a PTB. In the group not recommended AR (n = 981), 14.3% (n = 140) delivered preterm. Conclusion: In this cohort of women at high risk for PTB, activity restriction was associated with an increased risk of PTB. The use of AR in this population should be discouraged