Observational Descriptive Study of Clinical Outcomes on Extremely Obese Pregnant, Nulliparous Women Carrying a Single Term Fetus in Vertex Presentation (NTSV)


  • Reem Kashlan Wayne State University School of Medicine, USA
  • Alvin Varghesse Wayne State University School of Medicine, USA
  • Farnoosh Qadri Beaumont Health Dearborn, USA
  • Melissa Favot Beaumont Health Dearborn, USA
  • Federico G. Mariona Michigan Perinatal Associates, USA




Obesity in pregnancy, morbid obesity, extreme obesity, super obesity, massive obesity.


Obesity is a prime example of a non-contagious condition that has reached pandemic proportions. Efforts by the World Health Organization to establish standards of care for this population have not met with universal acceptance. Female obesity during the reproductive years has been consistently reported in association with adverse events, both for the mother and the fetus with short- and long-term health effects on both, including and not limited to cardiac disease, obesity and early death.

The effects of obesity are seen early in the reproductive period and are a continuum during prenatal care and delivery. Extreme maternal obesity is consistently reported in association with dysfunctional labor and increased risk for cesarean delivery and certain complications like post-partum hemorrhage and surgical site infection. We report a contemporaneous analysis of a limited cohort of nulliparous, extremely obese women with body mass index (BMI) ≥50 K/m², delivering at term (≥37 weeks gestation), carrying a single live normal fetus in vertex presentation (NTSV). These patients have been cared for by a limited number of board-certified obstetrical providers, in one institution. These patients were selected because they are considered candidates for an effort at safely reducing the cesarean rate. The results observed indicate a higher incidence of induction of labor, followed by failed induction of labor and delivery by cesarean compared with extant literature in the non-obese population. These results may represent a local practice that may not be generalizable to other geographic practice locations or a true decreased ability to reduce cesarean delivery in extremely obese pregnant women that merits additional considerations.

We encourage multi-institutional well conducted studies to determine if this population should be differentially considered as NTSV-XTO and reported as a separate group.


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