The ARRIVE trial compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. Its key finding regarding cesarean delivery rate was:

• A Induction at 39 weeks significantly increased the cesarean rate
• B Induction at 39 weeks significantly decreased the cesarean rate ✓
• C No difference in cesarean rate; induction increased perinatal mortality
• D Induction reduced cesarean rate only in women with unfavorable cervix

Explanation

The ARRIVE trial (2018) randomized low-risk nulliparous women to elective induction at 39 0/7 weeks vs. expectant management and found that the induction group had a lower cesarean delivery rate (18.6% vs. 22.2%, p=0.009). This was counterintuitive to the long-held belief that induction increases cesarean risk. The reduction may be explained by avoidance of postdates complications and improved cervical readiness at 39 weeks. Perinatal outcomes were similar. This trial has shifted practice toward offering elective induction at 39 weeks to low-risk nulliparas who desire it. There was no difference in serious perinatal complications.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.