Induction of labour for suspected fetal macrosomia

Abstract

Background: Women with a suspected macrosomic fetus are at risk of difficult operative delivery or caesarean section.Neonatal traumamay complicate the delivery. Induction of labour may reduce these risks by limiting the fetal growth and, therefore, decrease the birthweight. However, this intervention per se may be associated with an increased risk of caesarean section. Objectives: To assess the effects of a policy of labour induction for suspected fetal macrosomia on method of delivery and maternal or perinatal morbidity. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2009). Selection criteria: Randomised trials of induction of labour for suspected fetal macrosomia in non-diabetic women. Data collection and analysis: Both review authors independently assessed trial quality and extracted the data.We contacted study authors for additional information. Main results: We included three trials, involving 372 women. Compared to expectant management, induction of labour for suspected macrosomia has not been shown to reduce the risk of caesarean section (relative risk (RR) 0.96, 95% confidence interval (CI) 0.67 to 1.38) or instrumental delivery (RR 1.02, 95% CI 0.60 to 1.74). Perinatal morbidity was not statistically different between groups (shoulder dystocia: RR 1.06, 95% CI 0.44 to 2.56); one trial reported, however, two cases of brachial plexus injury and four cases of fracture in the expectant management group. Authors' conclusions: Induction of labour for suspected fetal macrosomia in non-diabetic women has not been shown to alter the risk of maternal or neonatal morbidity, but the power of the included studies to show a difference in rare events is limited. Larger trials are needed to address this question. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.