Induction of labour vs expectant management for LGA fetuses

Danny Tucker
Mind Map by Danny Tucker, updated more than 1 year ago
Danny Tucker
Created by Danny Tucker almost 5 years ago


By Dr Danny Tucker, Director of Obtetrics & Gynaecology, Townsville Hospital, Queensland, Australia. Boulvain, Michel et al. Lancet 2015. Original paper & editorial:

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Induction of labour vs expectant management for LGA fetuses
1 Induction of labour vs expectant management for large-for-date fetuses: a RCT. Lancet Online 9 April 2015
1.1 Results
1.1.1 409 IOL vs 411 expectant Baseline characteristics similar 10 days average difference in delivery date
1.1.2 Mean BW 3831g IOL vs 4118g expectant 50% reduction in >4000g infants & 75% reduction in >4500 infants
1.1.3 Primary outcome measure 8 (2%) of IOL and 25 (6%) of expectant management NNT = 25
1.1.4 Caesarean section/operative vaginal delivery, PPH & 3rd degree tears: No significant difference
1.1.5 TTN, NICU admission no difference Phototherapy 13% IOL vs 7% expectant, esp IOL<38/40
1.1.6 Individual outcomes Significant SD: 16 vs 5 (4% vs 1%) Delay of >60s: 10 vs 2 (2% vs 1%) Fracture: 8 vs 2 (2% vs 1%)
2 Background
2.1 CS to prevent macrosomia-related complications only for >4500g GDM & >5000g non-GDM
2.2 Systematic review of IOL vs conservative Mx = no difference in CS, but no reduction in morbidity
2.2.1 Small sample size
2.2.2 EFW>4000g & >=40/40, so lower benefit as baby already big
3 Study design
3.1 19 tertiary care hospitals in France, Switzerland & Belgium
3.1.1 2002-2009
3.1.2 Single, macrosomic fetus, cephalic, no CI to vaginal delivery
3.1.3 Sample size 500/500 for 80% power, 5% type 1 error & RR 0.33-0.5. Note study ended at 407/411 due to financial constraints
3.2 1:1 randomisation
3.3 IOL 37-38+6 within 3d of randomisation
3.4 Primary composite outcome: shoulder dystocia, # clavicle or long bone, brachial plexus injury, ICH or death
3.4.1 SD = not resolved with McRoberts/suprapubic pressure Note: also included >60s head-body interval But no reduction in benefit with IOL when this outcome excluded from analysis
3.5 Intention to treat analysis
3.6 Screening via clinically LGA
3.6.1 Hadlock >95%ile 3500g at 36 weeks, 3700g at 37 weeks, 3900g at 38 weeks
4 Mind map by Danny Tucker
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