Prediction of intrapartum cesarean delivery among women with obesity: A retrospective cohort study.

Objective: To determine risk factors and design a clinically based predictive model for the risk of intrapartum cesarean delivery (CD) in women with obesity.

Methods: A retrospective cohort study was conducted in a single tertiary medical center between 2012 and 2022 and included all consecutive women with a pre-gestational body mass index (BMI) ≥30 who planned a trial of labor. Uni- and multivariate analyses compared maternal and neonatal characteristics of women who delivered vaginally to those who underwent intrapartum CD. A specific risk prediction score was developed in accordance with the relative risk to predict the need for intrapartum CD.

Results: Of the 5663 women with obesity included in the study cohort, 424 (7.5%) underwent intrapartum CD and 5239 (92.5%) delivered vaginally. The independent risk factors for CD were maternal age >35 years, pre-gestational BMI category (BMI 35-40 and BMI >40), nulliparity, epidural anesthesia, induction of labor, antibiotic administration during labor, multiple gestation, previous uterine scar, and pre-eclampsia. The intrapartum CD prediction score model demonstrated predictive performance with 85% sensitivity and 70% specificity.

Conclusion: Score model for intrapartum CD can be used by caregivers to offer a more informed consultation to women with obesity facing the decision of mode of delivery.