The ARRIVE trial (2018) compared elective induction of labour at 39 weeks versus expectant management in low-risk nulliparous women. Its key finding was:

• A Elective induction at 39 weeks increased caesarean section rate compared to expectant management
• B Elective induction at 39 weeks increased neonatal ICU admissions compared to expectant management
• C Elective induction at 39 weeks did not increase caesarean section rate and was associated with lower perinatal morbidity composite ✓
• D Elective induction at 39 weeks increased maternal hypertensive disorders

Explanation

The ARRIVE trial (A Randomised Trial of Induction Versus Expectant Management, Grobman et al., NEJM 2018) enrolled 6,106 low-risk nulliparous women and found that elective induction at 39+0 to 39+4 weeks did NOT increase the caesarean section rate compared to expectant management (18.6% vs 22.2%, actually lower with induction). There was also a trend toward lower rates of the composite neonatal morbidity and mortality outcome in the induction group. This challenged the longstanding belief that elective induction increases caesarean risk, and has influenced ACOG guidelines on discussing 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.