The ARRIVE trial (NEJM 2018) compared elective induction at 39 weeks versus expectant management in low-risk nulliparous women. What was the primary finding?

• A Elective induction at 39 weeks reduced perinatal morbidity and was not associated with increased cesarean rates ✓
• B Elective induction at 39 weeks significantly increased cesarean delivery rates
• C Expectant management was superior due to lower maternal infection rates
• D Induction at 39 weeks was associated with significantly higher NICU admission rates

Explanation

The ARRIVE trial enrolled 6,106 low-risk nulliparous women and found that elective induction at 39 0/7 to 39 4/7 weeks did NOT increase cesarean delivery rates (18.6% vs 22.2% in expectant management arm, actually lower in induction group but not statistically significant as primary outcome met the non-inferiority threshold). There was a non-significant trend toward lower cesarean rates in the induction group, and perinatal morbidity was similar. This challenged the assumption that elective induction increases CS rates and led to revision of guidelines allowing elective induction at 39 weeks.

Reference: Williams Obstetrics, 26th ed.

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