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Archives of Gynecology and Obstetrics
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Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study

Authors: Lukas Jennewein; Lena Agel; Samira Catharina Hoock; Anna Elisabeth Hentrich; Frank Louwen; Nadja Zander;

Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study

Abstract

Abstract Purpose Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries—for instance in pregnancies with breech presentation—obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m2) in comparison to women with a BMI of below 25 kg/m2. Methods Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi2 testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study. Results Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m2 (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m2 (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi2 coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups. Conclusions Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.

Keywords

Adult, Infant, Newborn [MeSH] ; Obesity, Maternal/epidemiology [MeSH] ; Obesity, Maternal/complications [MeSH] ; Cohort Studies [MeSH] ; Pregnancy Complications/epidemiology [MeSH] ; Breech delivery ; Obesity/epidemiology [MeSH] ; Obesity ; Female [MeSH] ; Adult [MeSH] ; Humans [MeSH] ; Cesarean Section/statistics ; Retrospective Studies [MeSH] ; Pregnancy Complications/etiology [MeSH] ; Maternal BMI ; Pregnancy Outcome/epidemiology [MeSH] ; Obesity/complications [MeSH] ; Body Mass Index [MeSH] ; Overweight/complications [MeSH] ; Breech Presentation/epidemiology [MeSH] ; Perinatal outcome ; Maternal-Fetal Medicine ; Overweight/epidemiology [MeSH] ; Delivery, Obstetric/statistics ; Cesarean Section/adverse effects [MeSH] ; Pregnancy [MeSH], Cesarean Section, Pregnancy Outcome, Infant, Newborn, Pregnancy in Obesity, Overweight, Delivery, Obstetric, Maternal-Fetal Medicine, Body Mass Index, Cohort Studies, Pregnancy Complications, Pregnancy, Humans, Female, Obesity, Breech Presentation, Retrospective Studies

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    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
6
Top 10%
Average
Top 10%
Green
hybrid