Management of the Second Stage of Labor in Obese Nulliparous Women by Either Passive Descent or Immediate Pushing.
Conditions
Brief summary
Obesity rates in reproductive aged women in the United States are rising. It is now universally accepted that obesity is associated with many adverse pregnancy outcomes and post-operative complications following cesarean section. Recent studies have also shown an increased rate of cesarean section in obese women, adding to the already elevated rate of complications and adverse outcomes. Given the increased a priori risk for obese patients, it is vital that the investigators reexamine management practices routinely used for normal weight women in this specific high-risk population. Passive descent has been shown to increase the spontaneous vaginal delivery rate in non-obese women; however, high quality studies have never been performed in obese women. the investigators hypothesize that passive descent could improve the spontaneous vaginal delivery rate in nulliparous, obese women with regional anesthesia. This study will randomize women to passive descent for ninety minutes or active pushing upon entry into the second stage. Further, given that passive descent is widely accepted in the midwifery literature and clinical practice, the investigators anticipate that a high-quality study in the physician literature could increase the dialogue between practitioners and lead to development of best practices in this high-risk population.
Interventions
PROCEDUREPassive Descent
PROCEDUREPushing
Sponsors
Women and Infants Hospital of Rhode Island
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
FEMALE
Inclusion criteria
* Obese - body mass index (BMI) calculated as weight (kg)/ \[height (m2)\] greater than or equal to 30 as determined at the time of admission to labor and delivery * Regional anesthesia * Nulliparous (defined as no deliveries after 20 weeks gestation) * Gestational age of 37 0/7 weeks and greater * Singleton Pregnancy
Exclusion criteria
* Body mass index (BMI) calculated as weight (kg)/ \[height (m2)\] less than 30 as determined at the time of admission to labor and delivery * No regional anesthesia * Multiparous * Gestational age of less than 37 0/7 weeks * Multiple gestations * Maternal fever prior to second stage * Severe fetal anomalies (incompatible with life)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of spontaneous vaginal delivery | At delivery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of infections (defined as fever and / or antibiotic initiation) | participants will be followed for the duration of hospital stay, an expected average of 3 days | — |
| Rate of Third and Fourth Degree Lacerations | At delivery | — |
| Rate of Postpartum Hemorrhage | At delivery | — |
| Neonatal Outcomes | At delivery | * admission to NICU * umbilical cord pH \<7.1 |
Countries
United States
Contacts
Primary ContactAlisse Hauspurg, MD
Outcome results
None listed