SMFM: Induction of Labor Reduces Trauma Risk for Large-for-Date Fetuses

Inducing labor in the case of a suspected large-for-date fetus reduces the risk of trauma at birth compared with expectant management, according to a randomized controlled trial in collaboration with 20 European teaching hospitals.

A total of 817 women in the 37th to 38th week of gestation were enrolled in the study. Women were eligible if a sonographic evaluation established that the weight of the fetus was above the 95th percentile. Women were excluded if they were treating diabetes with insulin, or had a past history of cesarean section or shoulder dystocia. Women were randomized to either induction of labor within three days (n=407) or expectant management (n=410).

At delivery, mean birthweight differed by nearly 300 grams between the induction group (3831 g) and the expectant management group (4112 g). The induction of labor group saw reduced rates of neonatal trauma (2.2% vs 6.6%), and an increased likelihood of spontaneous vaginal delivery. Induction of labor did not increase the risk of cesarean section (28.0% in the induction group; 31.7% in the expectant group), and there were no other statistically significant difference in neonatal morbidities between the groups.

In the plenary session at the Society of Maternal and Fetal Medicine’s Annual Meeting, lead author Michael Boulvain, MD,  cited the controversial nature of induced labor as the motivation for the study, saying, “you’re damned if you do, damned if you don’t.”

Read our complete coverage of the Society of Maternal and Fetal Medicine's 32nd Annual Meeting, including:

SMFM: Progesterone Does Not Prolong Pregnancy After Successful Tocolytic Treatment

SMFM: LEEP Does Not Increase Risk of Preterm Birth

SMFM: CMA Should Become the Standard for Prenatal Diagnosis