6/28/23, 12:45 AM ARRIVE (labor) Pathway Feedback Search Clinical Topics Home Studies ARRIVE (labor) ARRIVE (labor) Disease Induction of labor Trial question Is labor induction superior to expectant management in low-risk nulliparous women? Study design Multi-center Open label RCT Population 6106 female patients Inclusion criteria: low-risk nulliparous women between 38 weeks 0 days to 38 weeks 6 days of gestation Key exclusion criteria: plan for cesarean delivery or contraindication to labor; signs of labor; fetal demise; premature rupture of membranes; vaginal bleeding Interventions N=3062 labor induction (induction of labor at 39 weeks 0 days to 39 weeks 4 days) N=3044 expectant management (elective delivery before 40 weeks 5 days and delivery initiated no later than 42 weeks 2 days) Primary outcome Perinatal death or severe neonatal complications 5.4 % 5.4 4.3 4.1 % 2.7 % Significant decrease 1.4 % NNT = 91 0 0 % https://web.pathway.md/studies/rec1b2DSXOiZbOrTa 1/2 6/28/23, 12:45 AM ARRIVE (labor) Pathway 0.0 % Labor induction Expectant management Significant decrease in perinatal death or severe neonatal complications (4.3% vs. 5.4%; RR 0.8, 95% CI 0.64 to 1) Secondary outcomes Significant decrease in cesarean delivery (18.6% vs. 22.2%; RR 0.84, 95% CI 0.76 to 0.93) Significant decrease in hypertensive disorders of pregnancy (9.1% vs. 14.1%; RR 0.64, 95% CI 0.56 to 0.74) No significant difference in neonatal intermediate or ICU admission (11.7% vs. 13%; RR 0.9, 95% CI 0.79 to 1.03) Conclusion In low-risk nulliparous women between 38 weeks 0 days to 38 weeks 6 days of gestation, labor induction was superior to expectant management with respect to perinatal death or severe neonatal complications. Reference William A Grobman, Madeline M Rice, Uma M Reddy et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. N Engl J Med. 2018 Aug 9;379(6):513-523. Open reference URL https://web.pathway.md/studies/rec1b2DSXOiZbOrTa 2/2