Passive Descent in Obese Nulliparous Gravidae

Status:Not yet recruiting
Conditions:Obesity Weight Loss
Therapuetic Areas:Endocrinology
Age Range:Any
Contact:Alisse Hauspurg, MD

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Can Passive Descent Increase the Spontaneous Vaginal Delivery Rate in Obese Women?

Obesity rates in reproductive aged women in the United States are rising. It is now
universally accepted that obesity is associated with many adverse pregnancy outcomes and
post-operative complications following cesarean section. Recent studies have also shown an
increased rate of cesarean section in obese women, adding to the already elevated rate of
complications and adverse outcomes. Given the increased a priori risk for obese patients, it
is vital that the investigators reexamine management practices routinely used for normal
weight women in this specific high-risk population. Passive descent has been shown to
increase the spontaneous vaginal delivery rate in non-obese women; however, high quality
studies have never been performed in obese women. the investigators hypothesize that passive
descent could improve the spontaneous vaginal delivery rate in nulliparous, obese women with
regional anesthesia. This study will randomize women to passive descent for ninety minutes
or active pushing upon entry into the second stage. Further, given that passive descent is
widely accepted in the midwifery literature and clinical practice, the investigators
anticipate that a high-quality study in the physician literature could increase the dialogue
between practitioners and lead to development of best practices in this high-risk

Inclusion Criteria:

- Obese - body mass index (BMI) calculated as weight (kg)/ [height (m2)] greater than
or equal to 30 as determined at the time of admission to labor and delivery

- Regional anesthesia

- Nulliparous (defined as no deliveries after 20 weeks gestation)

- Gestational age of 37 0/7 weeks and greater

- Singleton Pregnancy

Exclusion Criteria:

- Body mass index (BMI) calculated as weight (kg)/ [height (m2)] less than 30 as
determined at the time of admission to labor and delivery

- No regional anesthesia

- Multiparous

- Gestational age of less than 37 0/7 weeks

- Multiple gestations

- Maternal fever prior to second stage

- Severe fetal anomalies (incompatible with life)
We found this trial at
Providence, Rhode Island 02905
Providence, RI
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