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Elective Induction at 39 Weeks of Gestation and the Implications of a Large, Multicenter, Randomized Controlled Trial

Marrs, Caroline, MD; La Rosa, Mauricio, MD; Caughey, Aaron, MD, PhD; Saade, George, MD

doi: 10.1097/AOG.0000000000003137
Contents: Labor Induction: Current Commentary

On August 8, 2018, Grobman et al published the findings from the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, a large randomized controlled trial of elective induction of labor in nulliparous women at 39 weeks of gestation compared with expectant management. Conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, the trial found there was no difference between the two groups in the primary outcome, a composite of neonatal morbidity. Also, there was a reduction in rates of cesarean delivery and hypertensive disorders of pregnancy in the elective induction group. The topic of elective induction has been of interest to clinicians for decades, and research has yielded inconsistent results in the past. This trial offers the best evidence thus far to address this complex issue. Our objective is to briefly review the history and literature regarding elective induction of labor, discuss the recently published ARRIVE trial, and consider its implications on clinical practice and health policy.

Hospital system and obstetric service leaderships need to plan resource utilization before the potential benefits of elective induction at 39 weeks of gestation for low-risk nulliparous women are realized.

Departments of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, and Oregon Health & Science University, Portland, Oregon.

Corresponding author: Caroline Marrs, MD, 7777 Forest Lane Building D, 565, Dallas, TX 75230; email:

Financial Disclosure The University of Galveston Medical Branch was one of the sites for the ARRIVE trial. Dr. George Saade contributed to enrollment and manuscript development. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

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© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.