233: Timing of delivery for morbidly obese women

  • Merrill M
  • Aviram A
  • Lee V
  • et al.
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OBJECTIVE: While the prevalence of obesity is continuously rising, there is still controversy regarding the optimal timing of delivery among obese pregnant patients. While prior cost-effectiveness models have examined mainly early induction of labor in obese mothers, little information exists regarding the morbidly obese population. We aimed at establishing if early planned delivery in morbidly obese mothers reduces adverse outcomes and if this is a cost-effective strategy compared to expectant management. STUDY DESIGN: A decision-analytic model was created using TreeAge software to compare induction of labor (IOL) with expectant management at each gestational week between 37 and 41 weeks of gestation in morbidly obese women (BMI{>}40) with singleton pregnancies. In strategies involving expectant management, we accounted for the possibilities of IUFD, spontaneous delivery and IOL for non-reassuring NST at each successive week of gestation. All probabilities were derived from the literature. Outcomes included mode of delivery, maternal death, IUFD, neonatal death, cerebral palsy, and permanent brachial plexus injury (BPI) following shoulder dystocia. The cost-effectiveness threshold was set to {$}100,000 per quality-adjusted life year (QALY). RESULTS: In our theoretic cohort of 100,000 women, compared to expectant management until 39 weeks, IOL at 38 weeks prevented 5,541 cesarean deliveries, 1 maternal death, 68 IUFDs, 60 infant deaths and 9 BPIs but resulted in 20 more cases of cerebral palsy and was associated with an additional cost of {$}20 million. Compared to expectant management until 40 weeks, IOL at 38 or 39 weeks was cost-effective at incremental cost-effectiveness ratios of {$}15,448 and {$}13,597 per one additional QALY, respectively. IOL at 38 weeks was also incrementally cost-effective compared to expectant management until 39 weeks. Univariate sensitivity analyses found that IOL at 38 weeks was cost effective until the odds ratio of IUFD associated with morbid obesity fell below 1.42. CONCLUSION: IOL at 38 weeks in morbidly obese mothers improves perinatal outcomes and is a cost-effective intervention. (Table presented).




Merrill, M., Aviram, A., Lee, V., Senz, K., & Caughey, A. B. (2016). 233: Timing of delivery for morbidly obese women. American Journal of Obstetrics and Gynecology, 214(1), S138–S139. https://doi.org/10.1016/j.ajog.2015.10.271

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