The ARRIVE trial (NEJM 2018) studied elective induction of labour at 39 weeks versus expectant management in low-risk nulliparous women. What was its primary finding regarding caesarean section rates?
- A Elective induction at 39 weeks significantly increased the caesarean section rate
- B Elective induction at 39 weeks significantly reduced the caesarean section rate compared to expectant management ✓
- C There was no difference in perinatal outcomes or caesarean rates between groups
- D Elective induction was associated with increased neonatal ICU admissions
Correct answer: B. Elective induction at 39 weeks significantly reduced the caesarean section rate compared to expectant management
Explanation
The ARRIVE trial (A Randomised Trial of Induction Versus Expectant Management) unexpectedly found that elective induction at 39 weeks significantly REDUCED the caesarean section rate (18.6% vs 22.2%) compared to expectant management in low-risk nulliparas, without worsening perinatal outcomes. This counter-intuitive finding challenged the longstanding concern that induction of labour increases caesarean risk, and has significantly influenced practice guidelines on elective induction timing.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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