ARRIVE (labor induction)
Trial question
Is labor induction superior to expectant management in low-risk nulliparous women?
Study design
Multi-center
Open label
RCT
Population
6106 female patients
Inclusion criteria: low-risk nulliparous women between 38 weeks 0 days to 38 weeks 6 days of gestation
Key exclusion criteria: plan for cesarean delivery or contraindication to labor; signs of labor; fetal demise; premature rupture of membranes; vaginal bleeding
Interventions
N=3062 labor induction (induction of labor at 39 weeks 0 days to 39 weeks 4 days)
N=3044 expectant management (elective delivery before 40 weeks 5 days and delivery initiated no later than 42 weeks 2 days)
Primary outcome
Perinatal death or severe neonatal complications
4.3
5.4
5.4 %
4.1 %
2.7 %
1.4 %
0.0 %
Labor induction
Expectant management
Significant decrease ▼
NNT = 90
Significant decrease in perinatal death or severe neonatal complications (4.3% vs. 5.4%; RR 0.8, 95% CI 0.64 to 1)
Secondary outcomes
Significant decrease in cesarean delivery (18.6% vs. 22.2%; RR 0.84, 95% CI 0.76 to 0.93)
Significant decrease in hypertensive disorders of pregnancy (9.1% vs. 14.1%; RR 0.64, 95% CI 0.56 to 0.74)
No significant difference in neonatal intermediate or ICU admission (11.7% vs. 13%; RR 0.9, 95% CI 0.79 to 1.03)
Conclusion
In low-risk nulliparous women between 38 weeks 0 days to 38 weeks 6 days of gestation, labor induction was superior to expectant management with respect to perinatal death or severe neonatal complications.
Reference
William A Grobman, Madeline M Rice, Uma M Reddy et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug 9;379(6):513-523.
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