A Cochrane review [Abstract] 1 included 4 studies with a total of 1190 subjects. Women were included when fetal weight, estimated by ultrasound examination, was 4000 to 4500 g or 4000 to 4750 g, or fetus was over the 97th percentile curve. To prevent one fracture it would be necessary to induce labour in 60 women. Compared to expectant management, induction of labour for suspected macrosomia did not reduce the risk of caesarean section (RR 0.91, 95% CI 0.76 to 1.09; 4 trials, n=1190, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; n=1190, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 4 trials, n=1190, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; n=1190, high-quality evidence) were reduced in the induction of labour group. Mean birthweight was lower in the induction group, but there was considerable heterogeneity.
A meta-analysis 2 included 4 RCTs with 1190 non-diabetic women with suspected fetal macrosomia at term. There were not a significant difference in incidence of caesarean delivery (RR 0.91, 95% CI 0.76 to 1.09], operative and spontaneous vaginal delivery, shoulder dystocia, intracranial haemorrhage, brachial plexus palsy, Apgar score<7 at 5 min, cord blood pH<7, and mean birth weight compared with expectant management. The induction group had a significantly lower time to delivery (mean difference -7.55 days, 95% CI -8.20 to -6.89), lower rate of birth weight ≥4000 g (RR 0.50, 95% CI 0.42 to 0.59) and ≥4500 g (RR 0.21, 95% CI 0.11 to 0.39), and lower incidence of fetal fractures (RR 0.17, 95% CI 0.03 to 0.79)
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