Morbidly obese women have a higher risk of experiencing adverse pregnancy outcomes. The aim of this study is to determine which planned mode of delivery, elective cesarean section versus vaginal delivery, presents better maternal outcomes in morbidly obese women.METHODS:
We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in morbidly obese women without comorbidities delivering between 2000 and 2014. Multivariate logistic regression was used to compare outcomes in morbidly obese women according to mode of delivery.RESULTS:
We identified a total of 77,666 deliveries in otherwise healthy morbidly obese women. The planned cesarean group comprised 13.4% of the cohort. When compared to women in the planned vaginal group, the planned cesarean group was at higher risk for transfusion (OR 1.48 [95% CI 1.23–1.77]), chorioamnionitis (OR 1.61 [1.44–1.81]) and major puerperal infection (OR 1.28 [1.05–1.56]). Women in the planned cesarean group had a lower risk of postpartum cardiomyopathy (OR 0.07 [0.02–0.22]), amniotic fluid embolism (OR 0.08 [0.02–0.31]), deep vein thromboembolism (OR 0.25 [0.08–0.79]), sepsis (OR 0.18 [0.07–0.44]) and wound dehiscence (OR 0.36 [0.23–0.59]). These reduced risks in the latter are partly due to the high rate of cesarean among planned vaginal deliveries in which morbidities appeared highest.CONCLUSION:
Emergency cesarean section presents higher risks compared to planned cesarean section. Given that many planning a vaginal delivery will undergo emergency cesarean section, morbidly obese women should be informed of the high rate of failed vaginal delivery and subsequent risks.