Service Line Update: ARRIVE Trial Published

The ARRIVE trial, a randomized trial of induction of labor versus expectant management of first-time mothers at term, was completed in 2017, and the results were recently published in the New England Journal of Medicine. Many of the women enrolled in the study were local, due to Miami Valley Hospital being a research site of the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Maternal-Fetal Medicine Unit (MFMU). Therefore, this study is more likely to be generalizable to our local population.

The primary outcome of the study was a composite of adverse perinatal outcomes that were not different between the two groups. Secondary outcomes were significant for a lower frequency of cesarean delivery (18.6 percent vs. 22.2 percent), hypertensive disorders of pregnancy (9.1 percent vs. 14.1 percent), and respiratory support among newborns (3 percent vs. 4 percent) in the induction of labor group. The results of this study directly contradict the obstetrical dogma that induction of labor in nulliparous women increases the individual woman’s risk for cesarean delivery. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine reviewed the published results and concluded in a joint statement that “it is reasonable for obstetric care providers to offer an induction of labor to low risk women” who meet criteria used for the study inclusion (nulliparous, 39 weeks, absence of medical and obstetrical complications).

Thank you to the physicians and midwives who have generously allowed us to enroll their patients in the ARRIVE study, and other MFMU studies. Current MFMU studies include a randomized trial of prophylactic tranexamic acid after cesarean to reduce hemorrhage, a randomized trial of medical treatment of mild chronic hypertension in pregnancy, randomized trials of the Arabin pessary for asymptomatic short cervix in twins and singletons for the prevention of preterm birth, and a randomized trial of CPAP to prevent hypertensive diseases of pregnancy in women with mild or moderate obstructive sleep apnea.

David McKenna, MD, is the principal investigator; Samantha Wiegand, MD, is the co-investigator; and Kaye Snow, RN, BSN, C-EFM, is the nurse research coordinator for the MFMU studies at Miami Valley Hospital. Please feel free to contact them at (937) 208-2411 or by email if you would like to enroll a patient, or if you have any questions.

References:

ARRIVE Trial: N Engl J Med 2018; 379:513-23  
ACOG and SMFM statement 

Back to the October 2018 issue of Premier Pulse