Expectant management versus labor induction for suspected fetal macrosomia: a systematic review

CRD COMMENTARY:

The review question was clear in terms of the study design, intervention, participants and outcome. Several relevant sources were searched, the search terms were stated, no language restrictions were applied, and attempts were made to locate unpublished studies. Two reviewers extracted the data, which reduces potential errors and bias. However, since the methods used to select the studies were not described, the adequacy of the methods used cannot be evaluated. Study validity was not formally assessed, although the bias inherent in observational studies was discussed in the text of the review.
The characteristics of the studies were summarised and RCTs and observational studies were, appropriately, combined in separate meta-analyses. Statistical heterogeneity was assessed and a sensitivity analysis was conducted for one outcome to assess the influence of each study. Where significant heterogeneity was found (spontaneous vaginal delivery), potential reasons were not explored. Possible reasons for discrepant results between the RCTs and observational studies were considered in the review discussion. The evidence presented appears to support the authors' conclusions.