Washington, DC – The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) released the following statement in response to the results of “A Randomized Trial of Induction Versus Expectant Management,” more commonly referred to as the ARRIVE Trial, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and published in The New England Journal of Medicine:
“The ARRIVE Trial studied more than 6,100 first-time, healthy pregnant women across the country. Researchers randomly assigned half of the women to an expectant management group (waiting for labor to begin on its own and intervening only if problems occur) and the other half to a group that would undergo an elective induction (inducing labor without a medical reason) at 39 weeks of gestation.
“The ARRIVE Trial found no statistical difference in the primary outcome, which was a composite of perinatal mortality and severe neonatal morbidity, among the two groups of women. However, notable findings of the ARRIVE Trial include:
- A lower rate of cesarean birth, the major secondary outcome, among the induction group (18.6%) as compared to expectant management group (22.2%).
- Lower rates of hypertensive disorders of pregnancy (e.g. preeclampsia and gestational hypertension) among the induction group (9.1%) as compared to the expectant management group (14.1%).
- A lower rate of respiratory support among newborns born to the induction group (3%) as compared to the expectant management group (4%).
“ACOG and SMFM have reviewed the published results of the ARRIVE Trial and determined that it is reasonable for obstetric care providers to offer an induction of labor to low-risk women after discussing the options thoroughly, as shared decision making is a critical element. Women eligible for induction must meet the following criteria:
- Women who are planning their first delivery, are healthy and have no medical or obstetrical complications.
- Women who are 39 weeks pregnant and had an ultrasound performed early in the pregnancy to confirm dating.
“It is important for all inductions of labor, as was done in this study, to adhere to clinical protocols that optimize the chances of a vaginal delivery. Elective induction of labor should not be offered to women under circumstances that are inconsistent with the study protocol unless performed as part of research or quality improvement. As induction of labor involves coordination between the health care provider and the infrastructure in which induction and delivery will occur, it is critical that personnel and facilities coordinate polices related to the offering of elective induction of labor.
View the ACOG Practice Advisory: Clinical guidance for integration of the findings of The ARRIVE Trial: Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
View the SMFM Statement: SMFM Statement on Elective Induction of Labor in Low-Risk Nulliparous Women at Term: The ARRIVE Trial
In addition to the study, the NEJM also published an editorial by Michael Green, MD: Choices in Managing Full-Term Pregnancy