OB Paper Review: ARRIVE Trial

Grobman et al., (2018): https://www.nejm.org/doi/full/10.1056... The ARRIVE trial was a large randomized controlled trial that enrolled over 6,000 low-risk nulliparous women at 41 hospitals in the United States and international sites. The women were randomly assigned to either elective induction of labor at 39 weeks' gestation or expectant management (waiting for spontaneous labor). The trial excluded women with certain medical or obstetrical complications, such as gestational diabetes or preeclampsia. The primary outcome of the trial was a composite of adverse maternal and neonatal outcomes, including: Maternal: cesarean delivery, chorioamnionitis (infection of the fetal membranes), endometritis (infection of the uterus lining), and postpartum hemorrhage (excessive bleeding after delivery). Neonatal: a composite of perinatal death, Apgar score of 3 or less at 5 minutes, neonatal resuscitation, seizure, meconium aspiration syndrome (breathing problems caused by inhaling fecal matter), and hypoxic-ischemic encephalopathy (brain damage caused by lack of oxygen). The trial found that the rate of the primary outcome was not significantly different between the two groups: 18.6% in the elective induction group and 22.2% in the expectant management group. Specifically, there was no significant difference in the rates of cesarean delivery, chorioamnionitis, endometritis, perinatal death, or Apgar score of 3 or less at 5 minutes. However, the rate of neonatal intensive care unit (NICU) admission was significantly lower in the elective induction group compared to the expectant management group (4.4% vs. 5.4%). The trial authors concluded that elective induction of labor at 39 weeks' gestation in low-risk nulliparous women did not increase the risk of adverse maternal or neonatal outcomes, compared to expectant management. However, they noted that the decision of whether to induce labor should still be based on individual patient factors and preferences, and that additional studies are needed to evaluate the optimal timing of elective induction of labor. Overall, the ARRIVE trial provides important evidence to help inform the management of labor in low-risk nulliparous women, and its results have implications for clinical practice and healthcare policy. Main paper that assessed labor inductions with spontaneous labor. cesarean sections and hypertensive disorders were reduced in the induction group. Additionally, their primary outcome was perinatal outcomes which was not different between the two groups.