الفهرس 
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Abstract
Obesity is an expanding public health concern, with more than half of American women aged 20 to 36 years classified as overweight or obese and more than one in five women entering pregnancy classified as obese.The American College of Obstetricians and Gynecologists (ACOG) concurs with the World Health Organization and the National Institute of Health’s definition of obesity as body mass index (BMI) of 30 or more. Although there is ethnic variation, about one-third of the women are obese in the United States.Compared with women with BMI <30, obese women are at increased risk of spontaneous abortion, gestational diabetes, preeclampsia, and macrosomia. Additionally, compared with nonobese women, obese women are more likely to have cesarean delivery, secondary to failure to progress.Studies of the characteristics of labor in the obese gravid woman have been limited. We are aware of only two studies that examined the duration of second stage in a nulliparous population categorized by body mass index (BMI, calculated as weight (kg)/[height (m)]2). Obesity was associated with a shorter second stage than normal-weight control group participants in one study, whereas the other study demonstrated no difference in duration of second stage compared with normal-weight control group participants.Because of the limited data, the association between maternal weight and characteristics of the first and second stage of labor is uncertain.So This study was designed to estimate the length of the first and second stages of labor in nulliparous obese Egyptian women population and to compare them to those in women of normal body mass index.This study included 40 laboring nulliparous women at >37 weeks aging from 20 to 36 years and 40 normal subjects (age matched) as a control. They were selected from Bab El Sheria Hospital, Al-Azhar University, during the period extending from May 2012 to May 2013.
First visit BMI was used to categorize weight as normal (18.5 – 24.9) and obese (>30).During 12 months, the main results of the present study are:1- In our population at the start of pregnancy, two of three nulliparous women do not have normal weight and one of three is obese. Compared with other publications, the likelihood of obesity appears to be higher in our population. Because most women do not lose the weight gained during pregnancy, it is concerning that most of the nulliparous women in our population have BMI >25. With subsequent pregnancies, these women are more likely to have a higher BMI, which will increase the likelihood of complications.- As the BMI increases, so does the likelihood of diabetes, hypertension, induction, cesarean delivery, and macrosomia. These complications are consistent with earlier publications. It is noteworthy that among obese women in our population, macrosomia occurred in 5%, but this was significantly higher than those with BMI < 30.
3- The duration of stage (I) differs significantly among obese and normal-weight women. Even when adjusted for confounding variables, obese women are 27% less likely to reach the second stage of labor than women with a normal BMI. There are biologically plausible reasons for the prolonged first stage of labor among obese women.
4- No association between maternal BMI and the length of the second stage in nulliparous women. In addition, maternal BMI in nulliparous women reaching the second stage is not associated with a higher incidence of cesarean delivery.
Women met the inclusion criteria; 43% were obese. Duration of first stage of labor was significantly longer for obese versus normal weight women (19.76 ± 0.77 versus 16.87 ± 0.66 hours; p <0.001).
The cesarean delivery rate was significantly different between obese and normal-weight women, it was highest among obese (47%) and lowest in normal-weight women (24%). When adjusted for age, hypertension, and induction, the likelihood of completing stage I was significantly less among obese nulliparous than those with BMI < 24. Compared with those with BMI < 24, the duration of stage (I) is significantly longer among obese women, even when adjusted for maternal age, induction, and hypertension.
Our study supports the findings of Verdiales, Buhimschi, Cheng and Robinson in that we found no evidence of increased second-stage duration in women with increasing BMI. Furthermore, our results mirror those of (Fyfe et al) in that increasing BMI appears to be a risk factor for cesarean delivery in the first stage but not in the second stage of labor.These data suggest that the characteristics of the second stage of labor may be independent of maternal BMI. The second stage in the nulliparous parturient woman does not appear to be longer or more likely to end in cesarean delivery based on prepregnancy BMI. This knowledge may aid obstetric providers in counseling women about the expected effect of their BMI on their intrapartum course, as well as assist in clinical decision-making in women who reach the second stage of labor.