included only two small RCTs involving 313
women. The review by Sanchez-Ramos et al.19 included these
two RCTs as well as nine observational studies including 3751
subjects in total. Observational and RCTs were analysed separately.
Despite these methodological differences, the Irion
and Sanchez-Ramos analyses agreed in their main result, finding
no difference in caesarean deliveries or shoulder dystocia.
Sanchez-Ramos’ analysis of non-randomised studies suggested
that the risk for caesarean delivery may be increased
when induction of labour is undertaken for presumed macrosomia
(149 of 898 [16.6%] versus 214 of 2540 [8.4%], NNH =
12), a finding not confirmed in the small RCTs.19 Larger
randomised studies are underway to further elucidate this
question.