ABSTRACT
OBJECTIVE: To compare maternal and neonatal outcomes between planned cesarean delivery and induction of labor in women with class III obesity (body mass index ≥40 kg/m(2)). STUDY DESIGN: In this retrospective cohort study, we identified all women with a body mass index ≥40 kg/m(2) who delivered a singleton at our institution from January 2007 to February 2013 via planned cesarean or induction of labor (regardless of eventual delivery route) at 37-41 weeks. Patients in spontaneous labor were excluded. The primary outcome was a composite of maternal morbidity including death as well as operative, infection, and thromboembolic complications. The secondary outcome was a neonatal morbidity composite. Additional outcomes included individual components of the composites. Student t, χ(2), and Fisher exact tests were used for statistical analysis. To calculate adjusted odds ratios, covariates were analyzed via multivariable logistic regression. RESULTS: There are 661 mother-infant pairs that met enrollment criteria-399 inductions and 262 cesareans. Groups were similar in terms of prepregnancy weight, pregnancy weight gain, and delivery body mass index. Of the 399 inductions, 258 had cervical ripening (64.7%) and 163 (40.9%) had a cesarean delivery. After multivariable adjustments, there was no significant difference in the maternal morbidity composite (adjusted odds ratio, 0.98; 95% confidence interval, 0.55-1.77) or in the neonatal morbidity composite (adjusted odds ratio, 0.81; 95% confidence interval, 0.37-1.77) between the induction and cesarean groups. CONCLUSION: In term pregnant women with class III obesity, planned cesarean does not appear to reduce maternal and neonatal morbidity compared with induction of labor.
Subject(s)
Cesarean Section/methods , Intraoperative Complications/epidemiology , Labor, Induced/methods , Obesity, Morbid , Postoperative Complications/epidemiology , Pregnancy Complications , Adult , Cesarean Section, Repeat/methods , Cohort Studies , Delivery, Obstetric/methods , Endometritis/epidemiology , Female , Humans , Maternal Mortality , Multivariate Analysis , Obstetric Labor Complications/epidemiology , Odds Ratio , Postpartum Hemorrhage/epidemiology , Pregnancy , Retrospective Studies , Surgical Wound Infection/epidemiology , Young AdultABSTRACT
OBJECTIVE: It is unknown whether the Somali population in the United States is likely to participate in human papillomavirus (HPV) vaccination. We aimed to determine whether Somali girls living in a US community are following the recommendations for HPV vaccination. MATERIALS AND METHODS: We conducted a study of HPV vaccination among Somali girls seen at Mayo Clinic, Rochester, MN. Each Somali subject was matched by year of birth to white/non-Hispanic subjects in a 1:3 ratio. We abstracted information between August 1, 2006, and December 31, 2009, related to HPV vaccine series initiation and completion. Initiation and completion frequencies were compared between study groups using the χ(2) test. RESULTS: A total of 251 Somali and 727 white/non-Hispanic girls were identified, using the Rochester Epidemiology Project, who met all inclusion criteria for final analysis. A total of 114 Somali girls (45%) and 334 white/non-Hispanic girls (46%) initiated the series (odds ratio = 0.98; 95% confidence interval = 0.73-1.31), but only 59 Somali girls (52%) completed the vaccination series, compared with 240 (72%) of the white/non-Hispanic girls (odds ratio = 0.42; 95% confidence interval = 0.27-0.65). CONCLUSIONS: We found Somali girls to be generally accepting of initiating the HPV vaccine series but less likely to complete the series as compared with white non-Hispanic girls of the same age.
