Delivery Outcomes in Women with Body Mass Index ≥40: A Systematic Review and Meta-analysis [2E]
Bibliographic record
Abstract
INTRODUCTION: To compare delivery outcomes in pregnant women with a body mass index (BMI) ≥40based on the planned and actual mode of delivery. METHODS: Five databases were searched until July 2017 to identify studies that reported on delivery outcomes in women with BMI ≥40. Outcomes were presented as proportions. Relative risks (RR) and 95% confidence intervals were calculated using random-effects meta-analysis. RESULTS: Eight observational studies with low risk-of-bias (Newcastle-Ottawa Scale) were included. Based on 1597 pregnancies, planned vaginal birth (VB) vs. planned caesarean delivery (CD) was associated with higher risk for postpartum hemorrhage (PPH) [7.27% vs. 3.44%, RR 2.116 (1.02-4.40)] and low five-minute Apgars [4.51% vs. 1.53%, RR 2.955 (1.01-8.63)]. Based on 4144 pregnancies, planned trial of scar after caesarean vs. repeat CD was associated with higher risk for endometritis [4.97% vs. 2.19%, RR 2.22 (1.60-3.09)], low five-minute Apgars [4.94% vs. 1.68%, RR 2.98 (2.03, 4.28)], birth trauma [1.06% vs. 0.21% RR 4.61 (1.77-12.03)] and prolonged hospitalization [30.3% vs. 26% RR 1.163 (1.05-1.29)]. Based on 3625 pregnancies, successful VB vs. intrapartum CD was associated with lower risk of PPH [15.06% vs 69.96%, RR 0.21 (0.19-0.23)], wound disruption [0% vs. 4.44%, RR 0.05 (0.003-0.88)], prolonged hospitalization [1.9% vs. 6.67%, RR 0.28 (0.08-0.98)] and low five-minute Apgars (0.95% vs. 5.56%, RR 0.17 (0.03-0.86)], but more birth trauma [5.91% vs. 0.56% RR 6.56 (1.26-34.10)]. Compared groups had dissimilar demographic characteristics. CONCLUSION: Given the clinical equipoise, a randomized trial is needed to determine the optimal mode of delivery in women with BMI ≥40.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.024 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".