A 28-year-old nulliparous woman at 39 weeks undergoes elective induction of labour. The ARRIVE trial (2018, NEJM) evaluated elective induction at 39 weeks versus expectant management in low-risk nulliparas. The primary finding was:

• A Elective induction at 39 weeks significantly increased cesarean delivery rate
• B Elective induction at 39 weeks reduced perinatal morbidity and mortality by 30%
• C Elective induction at 39 weeks was associated with increased NICU admissions
• D Elective induction at 39 weeks did not increase cesarean delivery rate and was associated with lower rates of hypertensive disorders ✓

Explanation

The ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management, Grobman et al., NEJM 2018) demonstrated that elective induction of labour at 39 weeks in low-risk nulliparas did NOT increase the cesarean delivery rate (cesarean rate was actually slightly lower: 18.6% vs 22.2%). Additionally, elective induction was associated with lower rates of hypertensive disorders of pregnancy and shorter labour admissions. This challenged the traditional belief that induction without medical indication increased cesarean risk, leading to wider acceptance of elective induction at 39 weeks.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.