Induction of labor versus expectant management in macrosomia: a randomized study

Area of Science:

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

Background:

• Macrosomia at term is linked to increased maternal and neonatal morbidity, including higher rates of cesarean delivery and shoulder dystocia.
• Induction of labor is a proposed intervention to manage suspected macrosomia and improve outcomes.

Purpose of the Study:

• To evaluate the efficacy of labor induction in improving maternal and neonatal outcomes for pregnancies with suspected macrosomia at term.

Main Methods:

• A prospective randomized study comparing induction of labor versus expectant management in term pregnancies with estimated fetal weight between 4000-4500g.
• Exclusion criteria included diabetes, prior cesarean delivery, and nonvertex presentation.
• Key outcome measures: mode of delivery, cord arterial pH, shoulder dystocia, brachial plexus injury, clavicular fracture, cephalohematoma, and intraventricular hemorrhage.

Main Results:

• No significant difference in cesarean delivery rates (19.4% vs. 21.6%) between induction and expectant management groups.
• Similar rates of shoulder dystocia and comparable neonatal outcomes, including cord pH and incidence of intraventricular hemorrhage.
• Neonates in the expectant management group were significantly heavier.

Conclusions:

• Induction of labor for suspected macrosomia (4000-4500g) at term does not decrease cesarean delivery rates or neonatal morbidity.
• Ultrasonic fetal weight estimation within this range should not be an indication for labor induction.