The NTSV Challenge; They Are Not All Created Equal [22T]
Obstetrics & Gynecology
Obesity represents the prototypical example of a non-contagious endemic population health care concern. We explored the possible influences of extreme maternal obesity defined as a body mass index (BMI) of ≥50 k/mÂ2 on the primary cesarean rate of nulliparous patients, at term pregnancy, with a single live fetus and vertex presentation (NTSV), also classified as Robson TGCS group 2
A retrospective secondary analysis of prospectively collected administrative and clinical data in a limited cohort of extremely obese pregnant women care for in a single tertiary care hospital. Twins, non-vertex, preterm < 37 weeks gestation and multiparous were excluded.
Between 2008 and 2018 442 extremely obese pregnant women were included. 120 patients were NTSV (27.1%). The unadjusted primary cesarean rate was 78.7%, adjusted 55.5%. (OR=2.4). 55.4% of the patients were induced, with a diagnosed failed induction of 41%. The expected number of cesarean deliveries was 26; the observed number was 60, a clinical an statistical significant difference.
Maternal obesity continues to present a major health concern in the United States. Extreme obesity presents a clinical challenge during prenatal care and at delivery time. Efforts are in place to safely reduced the primary cesarean in the so called low risk pregnant women represented by the NTSV population. We have shown that extreme obesity in the NTSV population continues to militate against efforts at safely reducing the primary cesarean rate. We encourage a multiinstitutional effort to define the role of extreme obesity in safely reducing the primary cesarean rate.
Mariona, F. G. (2019). The NTSV Challenge; They Are Not All Created Equal [22T]. Obstetrics & Gynecology, 133 , 218S-219S. doi: 10.1097/01.AOG.0000559124.22186.ff.