Induction versus expectant management in cases of fetal macrosomia: a review of the literature.
Item
- Title
- Induction versus expectant management in cases of fetal macrosomia: a review of the literature.
- Author(s)
- Heath, R
- Abstract
- Background Historically and to the present day macrosomia was thought to be a reason for caesarean section as the mother’s pelvis is often assumed to be inadequate for the larger baby to pass through. Estimating the fetal weight before delivery continues to be inaccurate despite newer technology. Frequently caesarean delivery is recommended in cases of fetal macrosomia but this may be an unnecessary trauma for the mother. Objective To critically appraise the available research within the last 30 years: to explore the relationship between fetal macrosomia and caesarean section and the incidence of maternal morbidity. Design Structured literature review. Method A computerised search was conducted using Boolean operators in the following databases: PubMed, ScienceDirect, Google Scholar and the Greenwich portal online database. Articles were then included or excluded based on the following criteria:Inclusion Inclusion factors are tabulated in the methods section and include fetal macrosomia; birth weight >4000g; apgar score; studies from 1990 to 2018. Exclusion Exclusion factors are listed in the methods section. Results A lack of RCTs was noted, only two were useful; 20 years intervened between these studies; the later one was four times the size of its predecessor, stating that induction of labour for large-for-date foetuses reduces the risk of shoulder dystocia and increases the likelihood of spontaneous vaginal delivery. However, the results of the seven cohort studies, with larger samples, tended to show that expectant management of labour rather than induction of labour, was preferable to avoid maternal and neonatal morbidity. Discussion Prediction of fetal macrosomic remains an inexact science. Expectant management, rather than induction of labour, leads to better outcomes with reduced maternal morbidity; induction of labour frequently leads to caesarean section although it reduces the number of shoulder dystocia and brachial plexus injuries it is hard to justify given the increased cost and increased rates of maternal morbidity. Conclusion The low incidence of shoulder dystocia and brachial plexus injuries suggests that expectant management over induction of labour is warranted; however, with results of the two RCTs showing contradictory information, this suggests that a larger RCT should be carried out to benefit pregnant women expecting a suspected macrosomic fetus.
- presented at
- European School of Osteopathy
- Date Accepted
- 2019
- Date Submitted
- 19.11.2019 18:31:08
- Type
- osteo_thesis
- Language
- English
- Submitted by:
- 62
- Pub-Identifier
- 16498
- Inst-Identifier
- 1229
- Keywords
- >4000g; caesarean section; expectant management; fetal macrosomia; induction; pregnancy outcomes; shoulder dystocia.
- Recommended
- 0
- Item sets
- Thesis
Heath, R, “Induction versus expectant management in cases of fetal macrosomia: a review of the literature.”, Osteopathic Research Web, accessed May 2, 2025, https://www.osteopathic-research.com/s/orw/item/331