Content area

Abstract

Background

The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain.

Methods

In this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal complications; the principal secondary outcome was cesarean delivery.

Results

A total of 3062 women were assigned to labor induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk, 0.84; 95% CI, 0.76 to 0.93).

Conclusions

Induction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ARRIVE ClinicalTrials.gov number, NCT01990612.)

Details

Title
Labor Induction versus Expectant Management in Low-Risk Nulliparous Women
Author
Grobman, William A, MD; Rice, Madeline M, PhD; Reddy, Uma M, MD, MPH; Tita, Alan TN, MD, PhD; Silver, Robert M, MD; Mallett, Gail, RN, MS, CCRC; Hill, Kim, RN, BSN; Thom, Elizabeth A, PhD; El-Sayed, Yasser Y, MD; Perez-Delboy, Annette, MD; Rouse, Dwight J, MD; Saade, George R, MD; Boggess, Kim A, MD; Chauhan, Suneet P, MD; Iams, Jay D, MD; Chien, Edward K, MD; Casey, Brian M, MD; Gibbs, Ronald S, MD; Srinivas, Sindhu K, MD, MSCE; Swamy, Geeta K, MD; Simhan, Hyagriv N, MD; Macones, George A, MD, MSCE
Pages
513-523
Section
Original Article
Publication year
2018
Publication date
Aug 9, 2018
Publisher
Massachusetts Medical Society
ISSN
00284793
e-ISSN
15334406
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2087561785
Copyright
Copyright © 2018 Massachusetts Medical Society. All rights reserved.