Planned vaginal delivery or planned caesarean delivery in women with extreme obesity

Objective: To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)).

Design: A national cohort study using the UK Obstetric Surveillance System (UKOSS).

Setting: All hospitals with consultant-led maternity units in the UK.

Population: Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008.

Methods: Prospective cohort identification through UKOSS routine monthly mailings.

Main outcome measures: Anaesthetic, postnatal and neonatal complication rates.

Results: After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications.

Conclusions: This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.