Published last week and surrounded by a flurry of commentary and social media was
the ARRIVE trial.
1
This trial was based on the hypothesis that elective induction of labour at 39 weeks would reduce perinatal mortality and morbidity. Across 41 hospitals in the United
States, more than 6000 low-risk nulliparous women who were at 34 weeks 0 days to 38 weeks 6 days of gestation were randomised to either to induction of labour at 39 weeks 0 days to 39 weeks 4 days or to expectant management, which meant waiting beyond 40 weeks and 5 days to be induced but no later than 42 weeks and 2 days. The primary outcome was a composite of perinatal death and severe neonatal complications.
The main secondary outcome was caesarean section. There were no differences in the
primary outcome. Specifically, elective induction of labour at 39 weeks did not improve perinatal outcomes. However, induction of labour did significantly
reduce the rate of caesarean section, by 4%. The authors of the paper were tempered
in their conclusion, merely stating the finding in relation to the outcomes. However,
the wider response has been much less tempered, including a statement from the American
College of Obstetricians and Gynaecologists (released the same day as the full paper)
that it is reasonable for obstetricians and health-care facilities to offer elective
induction of labour to low-risk nulliparous women at 39 weeks gestation.
2
We are yet to see the formal response in Australia.To read this article in full you will need to make a payment
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References
- Labor induction versus expectant management in low-risk nulliparous women.N Engl J Med. 2018; 379: 513-523
- Practice advisory: clinical guidance for integration of the findings of the ARRIVE trial: labor induction versus expectant management in low-risk nulliparous women.American College of Obstetricians and Gynecologists, 2018 (Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Clinical-guidance-for-integration-of-the-findings-of-The-ARRIVE-Trial)
- Stillbirths: rates, risk factors, and acceleration towards 2030.Lancet. 2016; 387: 587-603
- Stillbirths: recall to action in high-income countries.Lancet. 2016; 387: 691-702
- Quarterly provisional estimates for infant mortality, 2015-quarter 3, 2017.Centers for Disease Control and Prevention, Atlanta, GA2018
- Australia’s mothers and babies 2016—in brief.AIHW, Canberra2018 (Perinatal statistics series no. 34. Cat. no. PER 97)
- Australia’s mothers and babies 1991.AIHW National Perinatal Statistics Unit, Sydney1994
- Victorian perinatal services performance indicators report 2016–17.Safer Care Victoria, Victorian Government, Melbourne2018
- Planned birth before 39 weeks and child development: a population-based study.Pediatrics. 2016; 138
- Saving babies’ lives project impact and results evaluation (SPiRE): a mixed methodology study.BMC Pregnancy Childbirth. 2018; 18: 43
- Scottish patient safety program maternity and children, end of phase report, August 2016.HIS, Scotland2016
- Midwife-led continuity models versus other models of care for childbearing women.Cochrane Database Syst Rev. 2016; (Art. No.: CD004667)https://doi.org/10.1002/14651858.CD004667.pub4
- Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.BMC Pregnancy Childbirth. 2016; 16: 28
- Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.BMC Pregnancy Childbirth. 2014; 14: 46
- Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial.BJOG. 2012; 119: 1483-1492
- Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard care.Br J Obstet Gynaecol. 2001; 108: 16-22
- Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs.Prev Med. 1986; 15: 451-474
Article info
Publication history
Published online: August 30, 2018
Identification
Copyright
© 2018 Published by Elsevier Ltd on behalf of Australian College of Midwives.
