Elective Induction of Labor in Nulliparas: has the ARRIVE trial changed obstetric practices and outcomes?

In 2018, the ARRIVE trial (Grobman et al. N Engl J Med. 2018) reported that 39-week elective labor induction in nulliparas decreased cesarean birth and pre-eclampsia rates compared with expectant management. The hypothesis was that this publication had an immediate impact on induction practices and decreased cesarean birth and preeclampsia rates over time.

There were 609,322 patients in the study group and 1,966,870 in the control group

https://www.ajog.org/article/S0002-9378(21)01352-1/fulltext

Conclusion

This study suggests that publication of a single randomized control trial (ARRIVE) rapidly influenced obstetric practice resulting in increased elective labor induction among nulliparas. In our population, decreases in cesarean birth and preeclampsia have not been realized raising questions about the applicability of the ARRIVE trial findings to a general obstetric population.