{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:21:19Z","timestamp":1783063279818,"version":"3.54.6"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp;amp; Obste"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Obesity class III, defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) exceeding 40, is associated with significant maternal and perinatal morbidity. The primary objective of this study was to evaluate the independent effect of class III obesity on mode of delivery and perinatal outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A matched case\u2013control study was conducted, involving pairing a cohort of 69 nulliparous patients with a BMI \u2265\u200940 to two control groups of pregnancies (70 with maternal BMI 30\u201339 and 70 with BMI &lt;\u200930). Subjects were matched for gestational diabetes mellitus (GDM) status and maternal age. Exclusion criteria were multiparity, multiple gestation, pregnancy loss &lt;\u200924\u2009weeks' gestation and pre\u2010pregnancy diabetes. Patterns across the BMI groups were tested using the Cochrane\u2010Armitage trend test and the Mann\u2010Kendall trend test. A\n                      <jats:italic>P<\/jats:italic>\n                      value less than 0.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      While the planned cesarean delivery (CD) rate was similar across BMI categories, class III obesity was independently associated with a statistically significant increase in the requirement for intrapartum CD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200932\/60 [53%, excluding elective prelabor CD]) compared with BMI 30\u201339 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924\/61 [39%, excluding elective prelabor CD]) and BMI &lt;\u200930 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200916\/62 [26%]) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). This increase was observed both in spontaneous and induced labor. The decision to induce labor was significantly higher in the class III obesity group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200949\/69 [82%]) compared with BMI 30\u201339 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200944\/70 [79%]) and BMI &lt;\u200930 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930\/70 [49%]) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The most prevalent complication was cesarean wound infection requiring re\u2010hospitalization, occurring in 20% of the class III group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Almost 60% of nulliparous pregnancies complicated by class III obesity require CD, the majority being intrapartum. Adjusting for the potential influence of maternal age and GDM status on perinatal decision making provides valuable insight into the independent effect of class III obesity on delivery outcome. When safely feasible, efforts should be directed toward awaiting spontaneous labor to optimize the prospect of achieving vaginal birth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.71207","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:06:15Z","timestamp":1783062375000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of class\n                    <scp>III<\/scp>\n                    obesity on mode of delivery and perinatal complications in nulliparous women: A matched case\u2013control study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6143-1221","authenticated-orcid":false,"given":"R\u00f3is\u00edn","family":"Gryson","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirisha","family":"Bellamkonda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa","family":"Asandei","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7942-9314","authenticated-orcid":false,"given":"Patrick","family":"Dicker","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciara","family":"Malone","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darya","family":"Musa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarwat Azeem","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4026-0945","authenticated-orcid":false,"given":"Ruair\u00ed","family":"Floyd","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eimer","family":"O'Malley","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5021-817X","authenticated-orcid":false,"given":"Enya","family":"Fullston","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Crimmins","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"O'Mahony","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2966-6987","authenticated-orcid":false,"given":"Fionnuala M.","family":"Breathnach","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Rotunda Hospital  Dublin Ireland"},{"name":"Royal College of Surgeons of Ireland  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"WHO.Obesity and overweight.2024https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/obesity\u2010and\u2010overweight"},{"key":"e_1_2_10_3_1","unstructured":"A. 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