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Q&A

Labor

Poster Session 2

(637) Effects of universal intrauterine pressure monitoring on labor outcomes among patients with obesity

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Eileen Xu, BA (she/her/hers)

Washington University in St. Louis, School of Medicine
St. Louis, MO, United States

Coauthor(s)

Nandini Raghuraman, MD MSCI (she/her/hers)

Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Katherine H. Bligard, MA,MD

Washington University School of Medicine in St. Louis
St. Louis, MO, United States
JK

Jeannie C. Kelly, MD, FACOG, MS

Associate Professor
Washington University School of Medicine in St. Louis, Barnes Jewish Hospital
St. Louis, MO, United States
Ebony B. Carter, MD, MPH (she/her/hers)

Associate Professor; Director, Division of Maternal Fetal Medicine
University of North Carolina at Chapel Hill
Chapel Hill, NC, United States
Alison G. Cahill, MD

Professor
University of Texas at Austin, Dell Medical School
Austin, TX, United States
Antonina I. Frolova, MD, PhD (she/her/hers)

Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, MO, United States

Objective: Labor in patients with obesity is associated with increased cesarean rates due to labor dystocia. Active labor management in this population is often complicated by suboptimal monitoring of uterine contractions using external tocodynamometry, contributing to over-diagnosis of labor dystocia. We hypothesized that universal intrauterine pressure catheter (IUPC) use in patients with obesity would result in decreased cesarean rates compared to provider-initiated IUPC use.

Study Design: This was a secondary analysis of a prospective study which included nulliparous patients with a BMI≥30kg/m² delivering at ≥37 weeks gestation at a single tertiary care center. Patients in this study had universal IUPC insertion at time of amniotomy (Universal-IUPC cohort) and were enrolled between 2020 and 2021. Historic controls were selected from nulliparous patients with IUPC use only at discretion of provider (PRN-IUPC) delivering between 2010 and 2014 at the same institution. Matching was performed on BMI and gestational age week at delivery in a 1:4 ratio. The primary outcome was cesarean delivery rate. Secondary outcomes were oxytocin use and maximum oxytocin dose. Multivariable logistic regression was used to compare outcomes between the Universal-IUPC and PRN-IUPC cohorts.

Results:

The Universal-IUPC cohort had 100% IUPC use while 76.2% of the PRN-IUPC cohort had an IUPC placed during labor. BMI and gestational age at delivery were similar between groups. Universal-IUPC cohort was older (27.3 vs 23.8 years, p< 0.01) and had more patients undergoing induction of labor (100 vs 57.4%, p< 0.01). Cesarean delivery rates for Universal-IUPC cohort were significantly lower than that of the PRN-IUPC cohort after adjusting for labor induction (27.9% vs 37.7%; aOR 0.39, 95%CI 0.30-0.74). Oxytocin use and maximum dose were not significantly different between the two cohorts.

Conclusion: Among patients with obesity, universal IUPC use may decrease cesarean rates. Further studies evaluating methods of uterine contraction monitoring in patients with obesity may decrease obstetric morbidity for this patient population.