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Although there is evidence to suggest that obese women with a BMI ≥40 experience increased rates of perinatal complications, there is limited data concerning rates of these complications compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. The aims of this study were to determine labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent labor management.This study included low risk women with a singleton, term pregnancy admitted in active labor or undergoing induction between May 2014 and April 2017 after the prevention of the primary cesarean delivery guidelines were implemented at our center. Patients were identified using an institutional IRB approved database. All demographic and perinatal outcomes were recorded. Women with prior hysterotomy and cesarean for non-reassuring fetal status were excluded.13,029 women met criteria. Guideline adherence decreased with increasing BMI, with 96% adherence among women of normal weight (BMI>18.5–25) compared to 81% for class III obese women (P<.05 adjusted for race, parity, neonatal weight and age). When guidelines were followed, there was no difference in rates of infectious morbidity or a maternal composite outcome including blood transfusion (P=.96, .48, .84 respectively). Although newborns of women with class III obesity had higher rates of meconium (P<.05), a composite of neonatal outcomes was not different with increasing maternal BMI (P=.60).With guideline adherence, there were no differences in adverse perinatal outcomes with increasing BMI.