Does induction of labor for constitutionally large-for-gestational-age fetuses identified in utero reduce maternal morbidity?

Abstract

Background: The number of infants with a birth weight > 97th percentile for gestational age has increased over the years. Although some studies have examined the interest of inducing labor for fetuses with macrosomia suspected in utero, only a few have analyzed this suspected macrosomia according to estimated weight at each gestational age. Most studies have focused principally on neonatal rather than on maternal (and still less on perineal) outcomes. The principal aim of this study was to assess whether a policy of induction of labor for women with a constitutionally large-for-gestational-age fetus might reduce the occurrence of severe perineal tears; the secondary aims of this work were to assess whether this policy would reduce either recourse to cesarean delivery during labor or neonatal complications.

Methods: This historical cohort study (n = 3077) analyzed records from a French perinatal database. Women without diabetes and with a cephalic singleton term pregnancy were eligible for the study. We excluded medically indicated terminations of pregnancy and in utero fetal deaths. Among the pregnancies with fetuses suspected, before birth, of being large-for-gestational-age, we compared those for whom labor was induced from ≥ 37 weeks to ≤ 38 weeks+ 6 days (n = 199) to those with expectant obstetrical management (n = 2878). In this intention-to-treat analysis, results were expressed as crude and adjusted relative risks.

Results: The mean birth weight was 4012 g ± 421 g. The rate of perineal lesions did not differ between the two groups in either primiparas (aRR: 1.06; 95% CI: 0.86-1.31) or multiparas (aRR: 0.94; 95% CI: 0.84-1.05). Similarly, neither the cesarean rate (aRR: 1.11; 95% CI: 0.82-1.50) nor the risks of resuscitation in the delivery room or of death in the delivery room or in the immediate postpartum or of neonatal transfer to the NICU (aRR = 0.94; 95% CI: 0.59-1.50) differed between the two groups.

Conclusions: A policy of induction of labor for women with a constitutionally large-for-gestational-age fetus among women without diabetes does not reduce maternal morbidity.

Figure 1

Description of the selection of patients for the study.