Labor Induction versus Expectant Management in Low-Risk Women

Labor Induction versus Expectant Management in Low-Risk Women


In the absence of a medical indication, labor induction between 39 weeks 0 days and 40 weeks 6 days of gestation has traditionally been avoided, given the lack of evidence of benefit, and the concern that it might increase the frequency of cesarean delivery. However, observational studies comparing elective labor induction with expectant management have called this approach into question. In the ARRIVE trial, a multicenter, controlled trial of 6106 low-risk nulliparous women, participants were randomly assigned to labor induction from 39 weeks 0 days to 39 weeks 4 days of gestation, or to expectant management. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. The primary outcome occurred in 4.3% of the induction group, and in 5.4% of the expectant management group, which after adjustment for an interim analysis, was not a significant difference. The rate of cesarean delivery was 18.6% in the induction group as compared with 22.2% in the expectant management group. The authors conclude that for low-risk, nulliparous women at 39 weeks of gestation, labor induction and expectant management resulted in similar rates of adverse perinatal outcomes, but induction of labor reduced the frequency of cesarean delivery. Full trial results are available at NEJM.org.

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