Characterizing vaginal misoprostol induction in individuals with and without severe obesity

To compare labor induction characteristics and delivery outcomes among individuals with body mass index < 40 versus ≥ 40 kg/m2 undergoing induction at term.

This secondary analysis utilized data from the vaginal misoprostol arm of a cluster randomized controlled trial comparing vaginal to oral misoprostol for induction. Individuals at ≥ 37 weeks gestation with cervical dilation ≤ 2 cm undergoing induction using a standardized protocol were included. Vaginal misoprostol was given in 25 µg doses every three hours for up to five doses, followed by a standardized oxytocin protocol. We compared labor progression among individuals with BMI < 40 and ≥ 40 kg/m2 at delivery, including labor duration, misoprostol use, and obstetric and neonatal outcomes. Generalized estimating equations were used to account for clustering and comorbid conditions. Effect sizes were presented as odds ratios and adjusted mean differences with 95% confidence intervals.