Obstetric and neonatal outcomes of different management strategies in fetal macrosomia

Fetal macrosomia is important to study given the high incidence of obstetric and neonatal complications. The induction of labor can reduce the incidence of adverse outcomes in complicated pregnancies. However, the effectiveness of labor induction in reducing the incidence of obstetric and neonatal complications in fetal macrosomia remains controversial.

Objective: To investigate obstetric and neonatal outcomes of different management strategies for fetal macrosomia (expectant management versus labor induction).

Materials and methods: This retrospective cohort study analyzed birth outcomes in 626 healthy primiparous women with fetal macrosomia. The patients were divided into a study group (n=334) with labor induction and a control group (n=295) with expectant management. Each group was divided into gestational age subgroups 1, 2, 3, and 4 of 37–38, 39, 40, and 41 weeks, respectively.

Results: The caesarean section rate for induction of labor at 37-39 weeks was not different from that in the expectant management group, whereas it was significantly higher at 40 weeks (p=0.02). However, at 41 weeks, the situation changed, and the rate of caesarean sections was significantly higher in the expectant management group (p=0.04). There were no differences in the rates of vaginal delivery, fetal shoulder dystocia, or perinatal outcomes.

Conclusion: With the development of fetal macrosomia, it is too late to count on the effectiveness of labor induction, which is the traditional approach to preventing complications. Preventing macrosomia and developing other approaches to prevent its adverse consequences are important.