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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPlanning a vaginal delivery provides optimal delivery and cost outcomes, according to a study that used a computational model to estimate the effect of induction of labor compared to expectant management of term pregnancies in obese women. They found that induction at 39 weeks of gestation minimized cesarean deliveries, stillbirths, and delivery-related health care costs.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPregnancy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EObstetrics \u0026amp; Gynecology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPlanning a vaginal delivery provides optimal delivery and cost outcomes, according to a study that used a computational model to estimate the effect of induction of labor compared to expectant management of term pregnancies in obese women. They found that induction at 39 weeks of gestation minimized cesarean deliveries, stillbirths, and delivery-related health care costs.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ELisa Gill, MD, of the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA, reported the outcomes of the study, which used a decision analysis model to evaluate the optimal timing of delivery and cost outcomes in a hypothetical cohort of 100,000 pregnancies in obese patients. The model used existing data to predict outcomes (ie, stillbirths, cesarean deliveries, and delivery-related health care costs) from routine induction at 39 weeks of gestation compared with expectant management and routine induction at 40, 41, and 42 weeks.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe data used in the model were extracted from previously published research on the likelihood of spontaneous labor, the rate of cesarean section with spontaneous and induced labor, and the risk of stillbirth by gestational age in obese patients. Study data that pertained to health care costs associated with vaginal or cesarean delivery were also extracted from previously published data.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe study found that routine induction at 39 weeks of gestation was associated with a decreased number of stillbirths, a reduction in cesarean sections, and significant cost savings when compared with delivery at 40, 41, and 42 weeks via expectant management or induction of labor.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ECompared with the worst-case model of expectant management with induction at 42 weeks, 387 stillbirths as well as 10,035 cesarean deliveries were avoided by routine induction at 39 weeks, with a savings in hospital costs of $29.3 million.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EComparing outcomes of induction at 39 weeks with the 2 worse-case models of expectant management and induction at 40 or 41 weeks, more than 9000 cesarean deliveries were avoided (30,888 vs. 40,025 and 40,122, respectively).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Gill emphasized that although the study indicates a benefit of early induction of labor at 39 weeks for obese patients, she cautioned that the results are limited by the computational nature of the study and its potential for biases that may have been present in the studies that were used to develop the model. She also cited a recently published study that reported the opposite findings: that obese women induced at 39 weeks had a significant increase in cesarean delivery when compared to expectant management [Wolfe X et al. \u003Cem\u003EAm J Obstet Gynecol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EShe emphasized the need for a prospective trial to better understand the optimal timing for delivery in obese women and mentioned a trial currently under development that will help to address this question (NICHD ARRIVE; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01990612\u0026amp;atom=%2Fspmdc%2F14%2F7%2F12.1.atom\u0022\u003ENCT01990612\u003C\/a\u003E).\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/7\/12.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp98d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}