Published last week and surrounded by a flurry of commentary and social media was the ARRIVE trial.
1This 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.
- Grobman W.
- Rice M.
- Reddy U.
- Tita A.
- Silver R.
- Mallett G.
- et al.
Labor induction versus expectant management in low-risk nulliparous women.
N Engl J Med. 2018; 379: 513-523
2We are yet to see the formal response in Australia.
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
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- 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)
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Published online: August 30, 2018
© 2018 Published by Elsevier Ltd on behalf of Australian College of Midwives.