• C S E Homer, J J Kurinczuk, P Spark, P Brocklehurst, and M Knight.
• National Perinatal Epidemiology Unit, University of Oxford, UK.
• BJOG. 2011 Mar 1;118(4):480-7.

ObjectiveTo compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ≥ 50 kg/m(2)).DesignA national cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll hospitals with consultant-led maternity units in the UK.PopulationFive hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008.MethodsProspective cohort identification through UKOSS routine monthly mailings.Main Outcome MeasuresAnaesthetic, postnatal and neonatal complication rates.ResultsAfter adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications.ConclusionsThis study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes.© 2011 The Authors Journal compilation © RCOG 2011 BJOG An International Journal of Obstetrics and Gynaecology.

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