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Intrauterine pressure during the second stage of labor in obese women.
Obstet Gynecol 2004; 103(2):225-30OG

Abstract

OBJECTIVE

The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate intrauterine pressure during the second stage of labor.

METHODS

Intrauterine pressure was prospectively measured in 71 women during the second stage of labor. Obesity was defined as a body mass index (BMI) greater than 29 (n = 17). A BMI below 25 was normal (n = 40). Women with a BMI between 26 and 29 (n = 14) were considered overweight. All women labored with epidural analgesia and were alert and responsive throughout the study. After recording the baseline contractility, a standardized Valsalva maneuver was performed during contractions. The area under the intrauterine pressure curve (integral) was used as an estimate of uterine contractility.

RESULTS

All women delivered vaginally. There were no significant differences in baseline uterine contractility among obese, overweight, and normal women either before (obese 1,787 mm Hg/s; 95% confidence interval [CI] 1,164, 2,742 versus normal 1,569 mm Hg/s; 95% CI 718, 2,371 versus overweight 1,770 mm Hg/s; 95% CI 1,305, 2,835; P =.223) or during Valsalva maneuver (obese 2,831 mm Hg/s; 95% CI 1,771, 4,599 versus normal 2,637 mm Hg/s; 95% CI 1,240, 4,390 versus overweight 2,813 mm Hg/s; 95% CI 1,209, 4,982; P =.742). A BMI greater than 25 was associated with a higher frequency of oxytocin augmentation (P =.037). Univariate analysis revealed a relationship between labor duration and BMI (r = 0.299, P =.018). Obese women labored longer during the active phase (one-way analysis of variance, P =.02), but second-stage duration was similar among groups (one-way analysis of variance P =.44). Obesity did not increase the incidence of perineal lacerations (P =.82) or frequency of operative delivery (relative risk obese versus nonobese = 0.212; 95% CI 0.04, 1.05).

CONCLUSION

Obese women produce second-stage intrauterine pressures equivalent to women with a normal BMI, although they may require oxytocin augmentation more often.

LEVEL OF EVIDENCE

II-2

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA. catalin.buhimschi@yale.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14754688

Citation

Buhimschi, Catalin S., et al. "Intrauterine Pressure During the Second Stage of Labor in Obese Women." Obstetrics and Gynecology, vol. 103, no. 2, 2004, pp. 225-30.
Buhimschi CS, Buhimschi IA, Malinow AM, et al. Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol. 2004;103(2):225-30.
Buhimschi, C. S., Buhimschi, I. A., Malinow, A. M., & Weiner, C. P. (2004). Intrauterine pressure during the second stage of labor in obese women. Obstetrics and Gynecology, 103(2), pp. 225-30.
Buhimschi CS, et al. Intrauterine Pressure During the Second Stage of Labor in Obese Women. Obstet Gynecol. 2004;103(2):225-30. PubMed PMID: 14754688.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrauterine pressure during the second stage of labor in obese women. AU - Buhimschi,Catalin S, AU - Buhimschi,Irina A, AU - Malinow,Andrew M, AU - Weiner,Carl P, PY - 2004/2/3/pubmed PY - 2004/3/9/medline PY - 2004/2/3/entrez SP - 225 EP - 30 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 103 IS - 2 N2 - OBJECTIVE: The perception that obese women have longer labors and a higher frequency of operative delivery because they are "poor pushers" persists despite the absence of objective study. We tested the hypothesis that obese women generate inadequate intrauterine pressure during the second stage of labor. METHODS: Intrauterine pressure was prospectively measured in 71 women during the second stage of labor. Obesity was defined as a body mass index (BMI) greater than 29 (n = 17). A BMI below 25 was normal (n = 40). Women with a BMI between 26 and 29 (n = 14) were considered overweight. All women labored with epidural analgesia and were alert and responsive throughout the study. After recording the baseline contractility, a standardized Valsalva maneuver was performed during contractions. The area under the intrauterine pressure curve (integral) was used as an estimate of uterine contractility. RESULTS: All women delivered vaginally. There were no significant differences in baseline uterine contractility among obese, overweight, and normal women either before (obese 1,787 mm Hg/s; 95% confidence interval [CI] 1,164, 2,742 versus normal 1,569 mm Hg/s; 95% CI 718, 2,371 versus overweight 1,770 mm Hg/s; 95% CI 1,305, 2,835; P =.223) or during Valsalva maneuver (obese 2,831 mm Hg/s; 95% CI 1,771, 4,599 versus normal 2,637 mm Hg/s; 95% CI 1,240, 4,390 versus overweight 2,813 mm Hg/s; 95% CI 1,209, 4,982; P =.742). A BMI greater than 25 was associated with a higher frequency of oxytocin augmentation (P =.037). Univariate analysis revealed a relationship between labor duration and BMI (r = 0.299, P =.018). Obese women labored longer during the active phase (one-way analysis of variance, P =.02), but second-stage duration was similar among groups (one-way analysis of variance P =.44). Obesity did not increase the incidence of perineal lacerations (P =.82) or frequency of operative delivery (relative risk obese versus nonobese = 0.212; 95% CI 0.04, 1.05). CONCLUSION: Obese women produce second-stage intrauterine pressures equivalent to women with a normal BMI, although they may require oxytocin augmentation more often. LEVEL OF EVIDENCE: II-2 SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/14754688/Intrauterine_pressure_during_the_second_stage_of_labor_in_obese_women_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=14754688.ui DB - PRIME DP - Unbound Medicine ER -