Planned Labor Induction at 39 Weeks for Nulliparous Women with BMI ≥ 35 kg/m2 Investigated to Reduce Cesarean Section Rates

Pregnant individuals with maternal obesity face a significantly higher likelihood of requiring labor induction and an increased risk of failed induction compared to those with normal weight. The precise mechanisms linking maternal obesity to labor dysfunction and subsequent cesarean delivery are not fully understood, representing a critical gap in obstetric care. While the landmark ARRIVE trial demonstrated that elective induction at 39 weeks in low-risk nulliparous women reduced cesarean rates without adverse perinatal outcomes, its findings may not directly translate to the higher-risk population of obese nulliparous women. This study aims to specifically address this gap, exploring whether a similar proactive approach can benefit this distinct demographic.

This prospective, randomized controlled trial is recruiting nulliparous women with a pre-pregnancy BMI ≥ 35 kg/m2. Participants are randomized to one of two arms: either planned induction of labor at 39 weeks or expectant management. The primary objective is to determine if planned induction of labor at 39 weeks reduces the incidence of cesarean section in this specific population. The study design directly compares an active intervention strategy against standard watchful waiting, aiming to provide evidence for a potentially safer and more effective labor management protocol for obese nulliparous patients.