Planned vaginal delivery or planned caesarean delivery in women with extreme obesity.

OBJECTIVE To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)). DESIGN A national cohort study using the UK Obstetric Surveillance System (UKOSS). SETTING All hospitals with consultant-led maternity units in the UK. POPULATION Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008. METHODS Prospective cohort identification through UKOSS routine monthly mailings. MAIN OUTCOME MEASURES Anaesthetic, postnatal and neonatal complication rates. RESULTS After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications. CONCLUSIONS This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.