The ARRIVE trial (2018, NEJM) compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. The primary perinatal outcome was not significantly different, but the perinatal death/serious complication composite trended lower with induction. What was the most clinically significant finding regarding maternal outcomes?

• A Elective induction at 39 weeks significantly increased the caesarean delivery rate
• B Elective induction significantly increased the rate of shoulder dystocia
• C Elective induction at 39 weeks significantly reduced the caesarean delivery rate compared to expectant management ✓
• D Elective induction significantly increased maternal infection requiring antibiotics

Explanation

Contrary to prior belief that induction of labour increases caesarean rate, the ARRIVE trial found that elective induction at 39 weeks in low-risk nulliparous women was associated with a significantly lower caesarean delivery rate (18.6% vs 22.2%) compared to expectant management. The proposed mechanism is that as gestational age advances, cervical unfavourability increases and the fetus grows larger, both increasing caesarean risk — induction at 39 weeks avoids this progression. This finding fundamentally changed practice and guidelines regarding elective induction.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.