COMMENT & CONTROVERSY

Obesity complicates the operative-delivery decision

“Operative vaginal delivery: 10 components of success,” by Michael A. Belfort, MD, PhD (February 2007)

Dr. Belfort outlined a strategy for determining the likelihood of success of operative vaginal delivery: “the rule of fifths.” I agree that this rule can be very helpful at the time of abdominal palpation, but it can be difficult to apply when the patient is obese. This is discouraging because the incidence of obesity is especially high in the United States, and obese women have an increased incidence of macrosomia and difficult operative delivery.