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Keywords:

  • Caesarean delivery;
  • mode of birth;
  • obesity;
  • pregnancy

Please cite this paper as: Homer C, Kurinczuk J, Spark P, Brocklehurst P, Knight M. Planned vaginal delivery or planned caesarean delivery in women with extreme obesity. BJOG 2011;118:480–487.

Objective  To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m2).

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.