The ARRIVE trial (NEJM 2016) evaluated routine induction at 39 weeks versus expectant management in low-risk nulliparous women. What was the primary conclusion of this trial?

• A Induction at 39 weeks did not increase cesarean delivery rates and was associated with lower rates of perinatal death, intubation, and NICU admission ✓
• B Induction at 39 weeks significantly increased cesarean delivery rates compared to expectant management
• C Induction at 39 weeks decreased NICU admissions but significantly increased neonatal respiratory morbidity
• D Expectant management beyond 39 weeks was superior in reducing both maternal and neonatal complications

Explanation

The ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) randomized 6,106 low-risk nulliparous women with singleton pregnancies at 38+0 to 38+6 weeks to elective induction at 39 weeks versus expectant management until 40+5 to 42+2 weeks. Contrary to historical assumptions, induction did NOT increase cesarean delivery rates (19% vs 22% in expectant group; RR 0.84). The induction group had lower rates of perinatal death, need for respiratory support, and NICU admission. Additionally, hypertensive disorders in pregnancy were less common in the induction group. This landmark trial changed clinical practice, and ACOG now supports offering elective induction to low-risk nulliparas at 39 weeks.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.