A Cochrane review included 4 studies with a total of 1190 subjects. Women were included when fetal weight, estimated by ultrasound examination, was 4000 to 4500 g or 4000 to 4750 g, or fetus was over the 97th percentile curve. Compared to expectant management, induction of labour for suspected macrosomia did not reduce the risk of caesarean section (RR 0.91, 95% CI 0.76 to 1.09; 4 trials, n=1190, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; n=1190, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 4 trials, n=1190, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; n=1190, high-quality evidence) were reduced in the induction of labour group. Mean birthweight was lower in the induction group, but there was considerable heterogeneity.
Comment: The quality of evidence is downgraded by study quality (no blinding).