Nulliparous with Class III Obesity at Term: Labor Induction or Cesarean Delivery Without Labor.

Objective To compare maternal and neonatal outcomes between labor induction versus CD without labor among nulliparous individuals with class III obesity (body mass index ≥ 40 kg/m2). Study design A retrospective cohort study of all nulliparous singleton deliveries ≥ 37 weeks with a BMI ≥ 40 kg/m2 at delivery between March 2020 and February 2022. We excluded individuals with spontaneous labor, fetal malformations, and stillbirths. The primary outcome was a composite of maternal mortality and morbidity, including infectious and hemorrhagic morbidity. The secondary outcome was a neonatal composite. A subgroup analysis evaluated patients with a body mass index ≥ 50 kg/m2. Another subgroup analysis compared outcomes between CD without labor and an indicated CD following induction. A multivariable logistic regression was applied. For adjustment, we used possible confounders identified in a univariate analysis. Results Among 8,623 consecutive deliveries during the study period, 308 (4%) met the inclusion criteria. Among them, 250 (81%) underwent labor induction, and 58 (19%) had a CD without labor. The most common indications for CD without labor were fetal malpresentation (26; 45%), suspected macrosomia (8; 14%), and previous myomectomy (5; 9%). Indicated CD occurred in 140 (56%) of the induced individuals, with the two leading indications being labor arrest (87; 62%) and non-reassuring fetal heart rate tracing (51; 36%). The rates of composite maternal morbidity (aOR 2.14, 95% CI 0.64-7.13) and composite neonatal morbidity (aOR 3.62, 95% CI 0.42-31.19) did not differ following a CD without labor compared to labor induction. The subgroup analyses did not demonstrate different outcomes between groups. Conclusions Among nulliparous individuals with class III obesity at term who underwent induction, more than 50% had indicated CD; the rate of short term maternal and neonatal morbidity, however, did not differ between labor induction and CD without labor.