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Expectant Management Versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review

Sanchez-Ramos, Luis MD; Bernstein, Sara MD; Kaunitz, Andrew M. MD


OBJECTIVE To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia.

DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing management of patients with suspected fetal macrosomia.

METHODS OF STUDY SELECTION We evaluated, abstracted data, and performed quantitative analyses in studies assessing the outcome of patients with suspected fetal macrosomia. Observational studies and randomized trials were included in this systematic review.

TABULATION, INTEGRATION, AND RESULTS Twenty-nine studies were identified, 11 of which met our criteria for systematic review and meta-analysis. These 11 studies included 3751 subjects. Of these, 2700 were managed expectantly, and 1051 underwent labor induction. We calculated an estimate of the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes, using random- and fixed-effects models for outcomes. Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labor had a lower incidence of cesarean delivery (OR 0.39, 95% CI 0.30, 0.50) and higher rates of spontaneous vaginal delivery (OR 2.07, 95% CI 1.34, 3,19); however, significant differences in these outcomes were not noted when the two randomized trials were assessed. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomized studies.

CONCLUSION Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes. Although their statistical power is limited, randomized clinical trials have not confirmed these findings.

Induction of labor for suspected fetal macrosomia appears to increase the cesarean delivery rate without improving perinatal outcomes.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida.

Address reprint requests to: Luis Sanchez-Ramos, MD, University of Florida, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 653–1 West 8th Street, Jacksonville, FL 32209; E-mail:

Received April 17, 2002. Received in revised form July 7, 2002. Accepted July 25, 2002.

© 2002 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.