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Early induction reduces the risk of injury during labour to babies that are large for date

Induction of labour for large-for-date fetuses might reduce risk of injury to the baby during labour without increasing the likelihood of a caesarean delivery.

Macrosomic (large body) fetuses are at increased risk of shoulder dystocia, an emergency in which the baby’s shoulders become stuck during labour. Elective caesarean is recommended only when fetal weight is estimated to exceed 4,500g for women with diabetes and 5,000g for those without diabetes.

Induction of labour significantly reduced the risk of shoulder dystocia in large fetuses

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Researchers investigated whether another option, induction of labour, would reduce the risks of macrosomia.

The randomised controlled trial was conducted between October 2002 and January 2009 in 19 tertiary care centres in France, Switzerland and Belgium. A total of 409 women were randomly assigned to have labour induced between 37 and 38 weeks’ gestation, or to expectant management.

Mean birthweight was 3,831g in the induction group and 5,118g in the expectant group. Induction of labour significantly reduced the risk of shoulder dystocia or association morbidity (n =8) compared with expectant management (n =25). There were no brachial plexus injuries, intracranial haemorrhages or perinatal deaths.

The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group. Caesarean delivery and neonatal morbidity did not differ significantly between the groups.

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