Induction of Labor Reduces Shoulder Dystocia in Suspected Large-for-Gestational-Age Fetuses: Meta-Analysis

BACKGROUND: Suspected large-for-gestational-age (LGA) fetuses are associated with increased risks of shoulder dystocia and adverse delivery outcomes, yet evidence on the effectiveness of induction of labor (IOL) remains inconsistent. OBJECTIVES: To evaluate whether IOL reduces shoulder dystocia and improves delivery outcomes in pregnancies with suspected LGA. METHODS: PubMed, Embase, Cochrane Library, ClinicalTrials.gov and Wanfang were searched from inception to June 30, 2025, without language restrictions. Randomized controlled trials including pregnant individuals ≥ 35 weeks with suspected LGA fetuses (>90th percentile or > 4000 g), comparing IOL with standard care, and reporting delivery outcomes. Two reviewers independently performed screening, data extraction, and risk of bias assessment. Frequentist random-effects meta-analyses, Bayesian models, and trial sequential analysis were conducted. GRADE framework was used to assess evidence quality. RESULTS: Five trials (N = 4,083) were included. IOL reduced shoulder dystocia (RR 0.68, 95% CI 0.49-0.95) and cesarean delivery (RR 0.87, 95% CI 0.79-0.96), and increased spontaneous vaginal delivery (RR 1.12, 95% CI 1.05-1.18). Trial sequential analysis indicated adequate information size. Bayesian analyses supported probable benefit, with stronger effects in per-protocol analyses. CONCLUSIONS: IOL for suspected LGA pregnancies reduces shoulder dystocia and improves delivery outcomes. These findings support reconsideration of existing clinical guidelines and may inform individualized counseling.