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Q&A

Labor

Poster Session 3

(671) Impact of Amniotomy Timing after Foley Bulb on Induction of Labor Outcomes in Obese Patients

Wednesday, February 14, 2024

8:30 AM – 10:00 AM

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

Primary & Presenting Author(s)

Annabeth Brewton, MD

Dr. Annabeth Brewton
University of Tennessee Graduate School of Medicine
Knoxville, TN, United States

Coauthor(s)

KL

Kristen Lilly, MD

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States
JM

Jill Maples, PhD

University of Tennessee Medical Center
Knoxville, TN, United States
AM

Alicia Mastronardi, MPH

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States
Megan L. Young, MPH

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States
sS

summer Shore, BS

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States
SS

Sarah Shelton, MD

University of Tennessee Graduate School of Medicine
Knoxville, TN, United States

Objective: Patients with obesity are less likely to spontaneously labor and more likely to require induction of labor (IOL) for pregnancy-related and comorbid conditions. Optimal timing of amniotomy in patients with obesity undergoing IOL is not well described and provider preference varies. We therefore aimed to describe the impact of timing of artificial rupture of membranes (AROM) on labor outcomes.

Study Design: This retrospective cohort study involved nulliparous patients with term, singleton, vertex pregnancies undergoing IOL at a single academic center from January 2020-May 2021. Patients with pre-pregnancy body mass index (BMI) > 30 kg/m2 undergoing cervical ripening with a foley bulb were included. Patients were grouped into quartiles by timing of amniotomy, defined as the earliest 25th percentile to the later 75th percentile. The primary outcome was total induction time, defined as time of foley bulb placement to delivery. Additional secondary outcomes were measured for the first quartile of amniotomy timing in comparison to the remaining three quartiles (Table 1). Fisher's Exact, Two-Sided or Pearson Chi-Square tests were used for data analysis with p < .05 used to define significance.

Results: Overall, 104 deliveries were analyzed with 26 patients in each quartile of amniotomy timing. Early amniotomy was associated with significantly less total induction time. There were no significant differences in rates of cesarean delivery, prolonged rupture of membranes, or chorioamnionitis (Table 1).

Conclusion: Among patients with a pre-pregnancy BMI > 30, earlier amniotomy may be associated with shorter overall induction times without increasing adverse outcomes. While retrospective, these data provide insight into the importance of amniotomy for labor induction and suggest amniotomy should not be delayed out of concern for predisposing patients to chorioamnionitis or cesarean delivery. Future work should include rates of obstetric hemorrhage and NICU admission. Ultimately, randomized controlled trials should be performed to better guide decisions for amniotomy timing in patients with obesity.