Elective Induction at 39 Weeks Reduces Need for Cesarean Deliveries

From left to right: Drs. Yasser El-Sayed and Ron Gibbs

Despite a paucity of evidence from clinical trials, obstetricians have long counseled women that inducing labor will increase their likelihood for cesarean birth. While life-saving in some circumstances, cesarean delivery carries significant risks including an increased chance for infection, hysterectomy, placental disorders in future pregnancies, and respiratory illness in infants. In order to evaluate the consequences of labor induction at 39 weeks, more than 6,100 first-time mothers at 41 hospitals across the country were randomized to labor induction or expectant management. Stanford Maternal-Fetal Medicine and Obstetrics Division Director Dr. Yasser El-Sayed served as PI for Stanford and Clinical Professor Dr. Ronald Gibbs (now at Stanford) served as PI for the University of Colorado.

Published August 9th in the New England Journal of Medicine, the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial found no statistical difference in the primary outcome, which was a composite of perinatal mortality and severe neonatal morbidity (Relative Risk (RR) 0.80, 95% Confidence Interval (CI) 0.64 to 1.00, P = 0.049). Healthy first-time mothers whose labor was induced in the 39th week of pregnancy were less likely to have a cesarean delivery, compared to a similar group who were not electively induced at 39 weeks (18.6% vs 22.2%, RR 0.84, 95% CI 0.76 to 0.93, P = < .001. Women in the induced group were less likely to experience pregnancy-related blood pressure disorders, such as preeclampsia and gestational hypertension, and their infants were less likely to need help breathing in the first three days. They also reported less pain in labor and a greater sense of autonomy over the labor process.

In response to these findings, The American College of Obstetricians and Gynecologists issued a Practice Advisory endorsed by the Society for Maternal-Fetal Medicine. They recommend that it is reasonable to offer elective induction of labor to low-risk nulliparous women at 39 weeks gestation, conditional upon the preferences of the pregnant woman, available resources, and setting in which the intervention would take place. Says Dr Gibbs, “The results of the ARRIVE trial show the how well-conducted clinical research establishes the basis for improved practice. It will be interesting to see how providers and patients adapt to these results."