BMI-Associated Labor Induction: A Prospective Trial

Eligibility Details: Inclusion Criteria: 1. Age 18 years and older 2. Pregnant, singleton gestation, vertex presentation 3. Nulliparous (no prior pregnancy delivered past 20 weeks) 4. Pre-pregnancy (self-reported in record of in EMR within 3 months of LMP) or 1st trimester (up to and including 14 weeks 0 days) BMI ≥ 35 kg/m2 5. Gestational age at enrollment 38 weeks 0 days and 38 weeks 6 days with dating confirmed by LMP and ultrasound performed prior to 20 6/7 weeks Exclusion Criteria: 1. Plan for induction of labor prior to 41 weeks 0 days for medical indication prior to study consideration 2. Plan for cesarean delivery or contraindication to labor 3. Major illness with increased risk of adverse pregnancy outcomes (e.g. pregestational diabetes with or without medication, gestational diabetes on medication, hypertension, cardiac disease, renal insufficiency, autoimmune disorder) 4. Multiple gestation 5. Non-vertex presentation 6. Fetal death 7. Fetus with major/lethal anomaly or aneuploidy (soft markers of aneuploidy, urinary tract dilation, isolated bowel dilation, mild ventriculomegaly, normal variants of vascular system, and isolated ventricular septal defects will not be excluded) a. Soft markers not qualifying as exclusion criteria: echogenic intracardiac focus, choroid plexus cyst, echogenic bowel, increased NT or nuchal fold, isolate short humerus or femur 8. Fetal growth restriction (EFW <10th percentile or AC <10th percentile) 9. Preeclampsia or gestational hypertension 10. Known oligohydramnios or polyhydramnios 11. Prior delivery after 20 weeks 12. Placenta/vasa previa 13. Placental abruption (known or suspected) or unexplained vaginal bleeding 14. Previous cesarean section, myomectomy, or classical cesarean 15. Spontaneous labor or suspicion of labor with regular contractions and cervical change, rupture membranes 16. Active genital herpes or HIV positive 17. Inability to consent 18. Any contraindication to a vaginal delivery 19. Delivery anticipated outside of Baystate Medical Center