Impending macrosomia: will induction of labour modify the risk of caesarean delivery?

Abstract

Objective To compare the annual incidence rates of caesarean delivery between induction of labour and expectant management in the setting of macrosomia. Design This is a retrospective cohort study. Setting Deliveries in the USA in 2003. Population Singleton births of macrosomic neonates to low-risk nulliparous women at 39 weeks of gestation and beyond. Methods Women who had induction of labour at 39 weeks of gestation with a neonatal birthweight of 4000 ± 125 g (3875–4125 g) were compared with women who delivered (either induced or spontaneous labour) at 40, 41 or 42 weeks (i.e. expectant management), assuming an intrauterine fetal weight gain of 200 g per additional week of gestation. Similar comparisons were made at 40 and 41 weeks of gestation. Chi-square test and multivariable logistic regression analysis were used for statistical comparison. Main outcome measures Method of delivery, 5-minute Apgar scores, neonatal injury. Results There were 132 112 women meeting the study criteria. In women whose labours were induced at 39 weeks and who delivered a neonate with a birthweight of 4000 ± 125 g, the frequency of caesarean was lower compared with women who delivered at a later gestational age (35.2% versus 40.9%; adjusted OR 1.25, 95% CI 1.17–1.33). This trend was maintained at both 40 weeks (36.1% versus 42.6%; adjusted OR 1.31, 95% CI 1.23–1.40) and 41 weeks (38.9% versus 41.8%; adjusted OR 1.16, 95% CI 1.06–1.28) of gestation. Conclusions In the setting of known birthweight, it appears that induction of labour may reduce the risk of caesarean delivery. Future research should concentrate on clinical and radiological methods to better estimate birthweight to facilitate improved clinical care. These findings deserve examination in a large, prospective, randomised trial.

Prenatal Detection and Consequences of Fetal Macrosomia

“…A Cochrane analysis and a systematic review stated that labour induction for suspected fetal macrosomia results in an increased caesarean delivery rate without improving perinatal outcomes [52,53]. Very recently, Cheng et al [54] found in a retrospective setting of known birth weight that induction of labour may reduce the risk of caesarean delivery compared with expectant management. Elective caesarean delivery in suspected fetal macrosomia has been proposed to prevent birth trauma and labour dystocia.…”

Gestational Diabetes Mellitus and Macrosomia: A Literature Review

“…Given that after 37 weeks of gestation the fetus continues to grow at a rate of 230 g/week [43], elective induction of labor before or near term has been proposed to prevent macrosomia and its complications [44]. However, there are two factors necessary for the induction of labor: the first is fetal lung maturation.…”

Can a customized standard for large for gestational age identify women at risk of operative delivery and shoulder dystocia?

“…Furthermore, a systemic meta-review concluded that the prenatal suspicion of LGA would not help to decrease the risk of vacuum delivery, emergent cesarean section, and shoulder dystocia [31] . On the contrary, a recent retrospective cohort study demonstrated that induction of labor might reduce the risk of cesarean delivery [7] . The optimal management of LGA has not been established.…”