The Optimal Method for Labor Induction in Macrosomic Fetuses: Mechanical or Medical?

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Research

Background:

• Fetal macrosomia increases risks of operative vaginal delivery, shoulder dystocia, obstructed labor, and cesarean section.
• Induction of labor (IOL) may mitigate these risks but can prolong labor and elevate cesarean section (CS) rates.
• Optimal IOL methods for macrosomic fetuses remain unclear, with limited data on medical induction efficacy.

Purpose of the Study:

• To compare the effectiveness and safety of medical versus mechanical induction of labor in pregnancies with fetal macrosomia.
• To evaluate the impact of different cervical ripening methods on delivery mode and maternal/neonatal outcomes.

Main Methods:

• Retrospective case-control study of women with IOL and macrosomic neonates (2010-2020).
• Exclusion criteria included non-cephalic presentation, prior CS, and multiple pregnancies.
• Primary outcome: mode of delivery; Secondary outcomes: maternal and neonatal complications.

Main Results:

• 247 women analyzed: 188 received prostaglandin E2 (PGE2) and 59 used a double-balloon catheter for cervical ripening.
• Mechanical induction group showed higher rates of previous deliveries >4000g and oxytocin use.
• No significant differences in operative vaginal delivery, cesarean section rates, or indications for CS between groups.
• Maternal and neonatal secondary outcomes were comparable across methods.

Conclusions:

• Prostaglandin E2 (PGE2) vaginal regimens and double-balloon catheters are safe and effective for cervical ripening in IOL for term pregnancies with macrosomic neonates.
• The choice of cervical ripening method (PGE2 vs. double-balloon catheter) did not influence the mode of delivery.
• Neither method demonstrated an impact on maternal or neonatal outcomes in this cohort.