INDUCTION OF LABOR VERSUS EXPECTANT MANAGEMENT IN MACROSOMIA - A RANDOMIZED STUDY

Objective: Macrosomia at term is associated with increased maternal an d neonatal morbidity, including a higher rate of cesarean delivery and shoulder dystocia. Induction of labor has been suggested as a means t o prevent further weight gain and improve outcome. The aim of this stu dy was to determine whether or not induction of labor in these cases i mproves maternal and neonatal outcome. Methods: Patients at term with an ultrasonic fetal weight estimation of 4000-4500 g were prospectivel y randomized into two groups: induction of labor (group I) and expecta nt management (group II). Patients with diabetes, a previous cesarean delivery, or nonvertex presentation were excluded. Outcome variables i ncluded mode of delivery, arterial cord pH, presence of shoulder dysto cia, brachial plexus injury, clavicular fracture, cephalohematoma, and intraventricular hemorrhage. Results: Of 273 patients who were eligib le for the study, 134 were randomized to group I and 139 to group II. Parity, gestational age, and fetal weight estimation were similar in t he two groups. The neonates of group II patients were significantly he avier (4132.8 +/- 347.4 versus 4062.8 +/- 306.9 g; P =.024). The rate of cesarean delivery was 19.4% in group I and 21.6% in group II patien ts (not significant [NS]). Cord pH was similar in both groups. Shoulde r dystocia was diagnosed in five group I and six group II patients (NS ). None developed brachial plexus injury. There were two cases of mild , transient brachial plexus injury in group II patients without docume nted shoulder dystocia. Mild intraventricular hemorrhage was diagnosed in three of 44 group I and two of 31 group II neonates evaluated (NS) . Conclusion: In this prospective, randomized study, induction of labo r for suspected macrosomia at term did not decrease the rate of cesare an delivery or reduce neonatal morbidity. Ultrasonic estimation of fet al weight between 4000 and 4500 g should not be considered an indicati on for induction of labor. (C) 1997 by The American College of Obstetr icians and Gynecologists.