Labor Onset and Length Abnormalities, Obesity
Conditions
Brief summary
The purpose of this study is to determine if ambulation with a labor epidural in place is associated with decreased rate of cesarean delivery in obese patients.
Detailed description
Obese women are known to have increased risk of cesarean delivery and prolonged labors. Low concentration epidural analgesia can achieve pain relief and allow for ambulation. Prior investigations have not shown a benefit in cesarean delivery between those who ambulate with an epidural and those who do not. These studies were conducted in women with normal weights. It is unknown if ambulation with a labor epidural is beneficial in decreasing cesarean delivery among obese women. Obese women at term with a singleton pregnancy will be enrolled in this pilot study. Patients will receive their epidural analgesia when they desire per standard protocol at our institution. Following epidural placement, a Modified Bromage Score and straight leg test will be performed. If the patient passes the straight leg test and has a modified Bromage score \> 6, they will be allowed to ambulate. They will be encouraged to ambulate for 20 minutes per hour with another adult alongside them. Obstetric care will be standard of care. On postpartum day one, the patient will be administered a Labor Agentry Scale. Chart review will then be conducted to review maternal and neonatal outcomes.
Interventions
BEHAVIORALAmbulation
Patients will be encouraged to ambulate for 20 minutes of every hour.
Sponsors
University of Chicago
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Masking description
The person completing analysis will be blinded to the treatment group.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
Subjects capable of giving consent Singleton pregnancy Nulliparous (defined as no previous pregnancy beyond 20 weeks 0 days) Gestational age greater than or equal to 37 weeks BMI \> = 35 at time of delivery admission Adult companion available Anticipated vaginal delivery
Exclusion criteria
Physical disability precluding ambulation Magnesium Administration Contraindications to neuraxial analgesia Cerclage in current pregnancy Active labor DPE Category III fetal heart tracing Fetal Demise In Utero
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cesarean Delivery Rate | At time of delivery | Percent of cesarean delivery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Labor Duration | From labor onset to time of delivery | Duration (hrs) |
| First Stage Duration | From onset of labor until complete dilation | Duration (hrs) |
| Second Stage Duration | From complete dilation until delivery | Duration (hrs) |
| Perceived Labor Control | Within 4 days postpartum | Score on Labor Agentry Scale |
Countries
United States
Outcome results
None listed