Induction of labor for a suspected large-for-gestational-age/macrosomic fetus

Fetal macrosomia is defined as a birth weight of >4000 g, while the term large for gestational age (LGA) is defined as an estimated fetal weight >90th centile for gestational age. Current data indicate that a significant proportion of the babies are LGA. Pregnancies involving LGA babies are associated with increased maternal and perinatal morbidity including caesarean section, postpartum hemorrhage, shoulder dystocia, and birth trauma. To reduce these complications, labor induction has been suggested as a possible solution. However, despite some high-quality evidence in favor of labor induction for suspected macrosomia/LGA, existing guidelines do not support routine induction of labor in this population. The aim of this paper is to critically appraise the available evidence and clinical practice recommendations and highlight the importance of shared decision making and individualized care based on clear counselling regarding the lack of a sensitive diagnostic tool for estimating fetal weight in the third trimester. •Current data for changes in birth weight indicate that a significant proportion of the babies born are large for gestational age (LGA).•LGA babies are associated with increased maternal and perinatal morbidity.•Hence, a diagnosis of LGA has implications on how and when labor is managed.•This problem is compounded by the fact that there is lack of precision in the diagnostic tool for LGA infants.•Even though the available evidence is supportive of induction for macrosomia, the decision should be based on clear counselling regarding the lack of a sensitive diagnostic tool and informed choice.