{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T16:18:33Z","timestamp":1784132313260,"version":"3.55.0"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T00:00:00Z","timestamp":1604620800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Pregnant women with a body mass index (BMI) \u226540\u00a0kg\/m<jats:sup>2<\/jats:sup> are at an increased risk of requiring planned\u2010 and unplanned cesarean deliveries (CD). The aim of this systematic review is to compare outcomes in women with BMI\u00a0\u2265\u00a040\u00a0kg\/m<jats:sup>2<\/jats:sup> based on planned and actual mode of birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Five databases were searched for English and French\u2010language publications until February 2019, and all studies reporting on delivery outcomes in women with BMI\u00a0\u2265\u00a040\u00a0kg\/m<jats:sup>2<\/jats:sup>, stratified by planned and actual mode of birth, were included. Risk\u2010of\u2010bias was assessed using the Newcastle\u2010Ottawa Scale. Relative risks (RR) and 95% confidence intervals were calculated using random\u2010effects meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ten observational studies were included. Anticipated vaginal birth vs planned CD (5 studies, n\u00a0=\u00a02216) was associated with higher risk for postpartum hemorrhage (13.0% vs 4.1%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, numbers needed to harm (NNH\u00a0=\u00a011), <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) but lower risk for wound complications (7.6% vs 14.5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, numbers needed to treat (NNT\u00a0=\u00a015), <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a058.3%). Planned trial of labor vs repeat CD (3 studies, n\u00a0=\u00a04144) was associated with higher risk for uterine dehiscence (0.94% vs 0.42%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.04, NNH\u00a0=\u00a0200, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%), endometritis (5.1% vs 2.2%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, NNH\u00a0=\u00a035, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%), prolonged hospitalization (one study, 30.3% vs 26.0%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.003, NNH\u00a0=\u00a023), low five\u2010minute Apgar scores (4.9% vs 1.7%, RR 2.95 (2.03, 4.28), NNH\u00a0=\u00a030, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) and birth trauma (1.1% vs 0.2%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, NNH\u00a0=\u00a0111, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%). Successful vaginal birth vs intrapartum CD (n\u00a0=\u00a03625) was associated with lower risk of postpartum hemorrhage (15.1% vs 70%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001, NNT\u00a0=\u00a02, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%), wound complications (one study, 0% vs 4.4%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.007, NNT\u00a0=\u00a023), prolonged hospitalization (one study, 1.9% vs 6.7%, 0.04, NNT\u00a0=\u00a021) and low five\u2010minute Apgar scores (one study, 1.0% vs 5.6%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.03, NNT\u00a0=\u00a022), but more birth trauma (5.9% vs 0.6%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.005, NNH\u00a0=\u00a019, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%). Compared groups had dissimilar demographic characteristics. Although studies scored 6\u20107\/9 on risk\u2010of\u2010bias assessment, they were at high\u2010risk for confounding by indication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Evidence from observational studies suggests clinical equipoise regarding the optimal mode of delivery in women with BMI\u00a0\u2265\u00a040\u00a0kg\/m<jats:sup>2<\/jats:sup> and no prior CD. This question is best answered by a randomized trial. Based on an unplanned subgroup analysis, for women with BMI\u00a0\u2265\u00a040\u00a0kg\/m<jats:sup>2<\/jats:sup> and prior CD, repeat CD may be associated with better clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14011","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T19:46:18Z","timestamp":1601495178000},"page":"200-209","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Birth outcomes in women with body mass index of 40\u00a0kg\/m<sup>2<\/sup> or greater stratified by planned and actual mode of birth: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-2017","authenticated-orcid":false,"given":"Rohan","family":"D\u2019Souza","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Mount Sinai Hospital University of Toronto Toronto ON Canada"},{"name":"Lunenfeld Tanenbaum Research Institute Toronto ON Canada"},{"name":"University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Horyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude\u2010Emilie","family":"Jacob","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Mount Sinai Hospital University of Toronto Toronto ON Canada"},{"name":"Department of Obstetrics and Gynecology Centre Hospitalier Universitaire de Montreal Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nusrat","family":"Zaffar","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Mount Sinai Hospital University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Horn","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Maxwell","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Mount Sinai Hospital University of Toronto Toronto ON Canada"},{"name":"University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0202183"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ajogmf.2019.100041","article-title":"Maternal body mass index and pregnancy outcomes: a systematic review and metaanalysis","volume":"1","author":"D\u2019Souza R","year":"2019","journal-title":"Am J Obstet Gynecol \u2010 MFM"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2010.531313"},{"issue":"244","key":"e_1_2_10_5_1","first-page":"e241","article-title":"Contemporary labor patterns: the impact of maternal body mass index","volume":"205","author":"Kominiarek MA","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2018.08.018"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(16)35244-6"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12032"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_10_11_1","unstructured":"DeeksJJ HigginsJPT AltmanDG.Chapter 10: Analysing data and undertaking meta\u2010analyses. 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