Comparison of maternal and perinatal outcomes in women with super obesity based on planned mode of delivery

Background: Currently, little evidence exists to guide mode of delivery in pregnant women with super obesity. There is a trend toward elective caesarean delivery in this population with little evidence of improved maternal or neonatal outcomes. Aim: Our study compares maternal and neonatal outcomes based on planned mode of delivery and aimed to identify predictors for a successful vaginal delivery. Materials and Methods: This retrospective observational study explored maternal and neonatal outcomes of women with a body mass index ≥50 who birthed following a singleton pregnancy at ≥36 weeks gestation over a 10 year period at a single centre in Melbourne, Australia. Outcomes between women having a planned vaginal or planned caesarean birth were compared on an intention-to-treat basis, with logistic regression used to determine factors predictive of a vaginal birth. Results: A total of 275 women with super obesity were identified. One hundred and ninety-nine (72%) planned a vaginal birth, which was successful for 70%. Planned vaginal birth was associated with lower rates of postpartum complications requiring readmission (5% vs 16%; P = 0.003). Neonatal resuscitation requirements and Apgar scores at five minutes were similar between groups. Multiparity was the strongest predictor of a successful vaginal birth while medical intervention in labour was associated with a reduced rate of success in primiparous women. Conclusions: Contrary to current trends in practice, a trial of labour for women with super obesity, when facilities and skills permit, appears a safe option for mother and baby.