Improving Labor Management for Patients With Severe Obesity Using Abdominal Pannus Retraction

Maternal obesity is one of the most important contributors to pregnancy complications such as cesarean delivery and hemorrhage in Wisconsin, representing a growing public health challenge. According to the Wisconsin Department of Health Services, approximately 28% of women entering pregnancy have obesity, and the prevalence of maternal obesity and other disease comorbidities has steadily increased. As the number of pregnancies complicated by obesity continue to rise, so does those complicated by severe obesity (body mass index / BMI > 40), so does the burden of prolonged labor and significant maternal morbidity including cesarean delivery, postpartum hemorrhage, wound complications, infection, and blood clots. These complications increase healthcare utilization, hospitalization, and contribute to persistent maternal morbidity across Wisconsin. Froedtert and the Medical College of Wisconsin Birth Center serve as one of southeastern Wisconsin's largest tertiary obstetric referral centers, (including transfers for obesity due to increased delivery risk), providing care for a large and medically complex obstetric population. In 2025 alone, approximately 4,100 deliveries occurred at the Birth Center, and more than half (60%) of pregnant patients were complicated by obesity and/or obesity-related medical conditions. Our birth center is the ideal environment to evaluate interventions intended to improve labor outcomes among pregnant patients with obesity. One of the greatest challenges during childbirth for patients with obesity is an abnormal labor, in which cervical dilation progresses more slowly than expected or does not progress despite appropriate medical management.7-27 Compared with patients without obesity, patients with obesity are significantly more likely to experience an abnormal labor time, challenge with movement and monitoring of the child's welling being, require longer labor augmentation with more medication, have a failed induction of labor, require cesarean delivery, and ultimately suffer more labor complications such as hemorrhage.

Although obesity is one of the most common pregnancy complications encountered in obstetric practice, clinicians have minimal evidence-based interventions designed to address the slower labor progression that has been attributed to obesity. There has been increasing presence on social media platforms, particularly TikTok, regarding the use of abdominal pannus elevation/retraction during labor as a strategy to facilitate fetal descent and vaginal birth. Although this technique has generated substantial anecdotal interest among clinicians and influencers, there is limited published evidence evaluating its effectiveness in labor despite it being a simple bedside intervention used in ultrasound and to facilitate cesarean delivery. By elevating the abdominal soft tissue in patients with obesity, pannus retraction may also improve labor biomechanics by reducing pressure on the gravid uterus and fetal presenting part, thereby facilitating the cardinal movements of labor including appropriate cervical dilation, fetal descent, and rotation and ultimately vaginal delivery. Despite its clinical use for ultrasound and cesarean delivery, notably with high patient and provider satisfaction, abdominal pannus retraction has never been rigorously evaluated in a randomized clinical trial during childbirth.

This project directly addresses an important gap in maternal healthcare by evaluating whether standardized abdominal pannus retraction can safely improve labor progression among patients with severe obesity and reduce maternal complications such as cesarean delivery and hemorrhage. Because the intervention is inexpensive and already utilized into clinical care for cesarean delivery, even modest improvements in labor progression, time or reduction in cesarean delivery could improve maternal outcomes while reducing healthcare utilization, clinician injury, and/or costs throughout Wisconsin. The knowledge generated from this pilot study will provide the preliminary evidence necessary to design a larger efficacy trial and position Wisconsin to be at the forefront of improving childbirth among patients with obesity.

The overall goal of this project is to determine whether a randomized clinical trial evaluating standardized abdominal pannus retraction during labor and delivery is feasible while generating preliminary evidence regarding its effects on labor progression and maternal outcomes. During the 12-month project period, 100 pregnant patients with singleton, cephalic pregnancies at 37 weeks' gestation or greater, a body mass index of at least 40 kg/m² will be enrolled.

Following informed consent, participants will be randomly assigned in a 1:1 to receive either routine obstetric care alone (control arm) or routine obstetric care combined with standardized abdominal pannus retraction (intervention arm) using the Panni XL device. The intervention will continue until delivery. The primary clinical outcome will be the time from randomization to delivery. Secondary outcomes will include time to complete cervical dilation, duration of the second stage of labor, mode of delivery, oxytocin utilization, postpartum hemorrhage, maternal complications such as wound infection, neonatal outcomes, patient satisfaction, and multidisciplinary provider (i.e. nursing, obstetrician, midwife) acceptability. An equally important objective of this pilot study is to determine whether a larger randomized trial can be successfully conducted. Feasibility will be evaluated by measuring participant recruitment, enrollment, intervention adherence, protocol completion, provider compliance, participant tolerability, and safety. These findings will provide critical information for designing a future adequately powered multicenter clinical trial.