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Thread: Article: ACOG does not approve induction for large babies

  1. #1

    Join Date
    Feb 2003
    Melbourne, Victoria, Australia, Australia

    Default Article: ACOG does not approve induction for large babies

    Just to clarify first:

    ACOG - American College Obs & Gyns
    fetal macrosomia - large baby i.e. as per often women with GD are told they may have.


    Expectant Management Versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review

    Luis Sanchez-Ramos, MD, Sara Bernstein, MD and Andrew M. Kaunitz, MD
    From the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida.

    Address reprint requests to: Luis Sanchez-Ramos, MD, University of Florida, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 653-1 West 8th Street, Jacksonville, FL 32209; E-mail: [email][email protected][/email].

    OBJECTIVE: To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia.

    DATA SOURCES: We supplemented a search of entries in electronic databases with references cited in original studies and review articles to identify studies assessing management of patients with suspected fetal macrosomia.

    METHODS OF STUDY SELECTION: We evaluated, abstracted data, and performed quantitative analyses in studies assessing the outcome of patients with suspected fetal macrosomia. Observational studies and randomized trials were included in this systematic review.

    TABULATION, INTEGRATION, AND RESULTS: Twenty-nine studies were identified, 11 of which met our criteria for systematic review and meta-analysis. These 11 studies included 3751 subjects. Of these, 2700 were managed expectantly, and 1051 underwent labor induction. We calculated an estimate of the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes, using random- and fixed-effects models for outcomes. Summary statistics for the nine observational studies showed that, compared with those whose labor was induced, women who experienced spontaneous onset of labor had a lower incidence of cesarean delivery (OR 0.39, 95% CI 0.30, 0.50) and higher rates of spontaneous vaginal delivery (OR 2.07, 95% CI 1.34, 3,19); however, significant differences in these outcomes were not noted when the two randomized trials were assessed. No differences were noted in rates of operative vaginal deliveries, incidence of shoulder dystocia, or abnormal Apgar scores in the analyses of the observational or randomized studies.

    CONCLUSION: Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes. Although their statistical power is limited, randomized clinical trials have not confirmed these findings.
    Kelly xx

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  2. #2

    Join Date
    Dec 2005
    In Bankworld with Barbara


    I think every woman should be given the chance to birth their babies naturally before intervention is used. Unless there is a medical reason for the health of the baby and Mum I think it is a pathetic excuse to induce babies because they appear large (which often they are not). There is no way of knowing until the time comes if a woman can birth a 'large' baby or not.

    I think in GD cases there is enough risk to the baby being born with high blood sugar levels as it is without having them born before they are ready, which can bring about it's own set of complications.

  3. #3
    Kirsty77 Guest


    Wow that article is so sopt on. You know I had a think about all the women I know that were induced and all of them had c/s's!!

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