Publication of ARRIVE trial linked to increase in 39-week induction

An increase in 39-week induction rates and a decrease in cesarean delivery (CD) rates were seen following publication of A Randomized Trial of Induction vs. Expectant Management (ARRIVE) in August 2018, according to a research letter published online Aug. 10 in JAMA Network Open.

Rachel Wood, M.D., from Brigham and Women’s Hospital in Boston, and colleagues examined whether publication of the ARRIVE trial in August 2018, which revealed that low-risk nulliparous patients who were induced at 39 weeks of gestation had a reduced risk for CD, was associated with observable obstetric practice changes in the United States. Data were obtained for 2,860,942 births (66 and 34 percent from the pre-ARRIVE and post-ARRIVE periods, respectively).

The researchers observed an immediate increase in 39-week induction rates after the dissemination period, with a 39-week induction rate of 15.0 percent compared with an expected 13.8 percent based on trends during the pre-ARRIVE period (adjusted incident rate ratio [aIRR], 1.10); CD rates were significantly lower than expected (24.7 versus 25.1 percent; aIRR, 0.988). Significant ongoing temporal changes included an increase of 0.009 39-week inductions and a decrease of 0.0014 CDs per month.

“These findings suggest that the publication of the ARRIVE trial was associated with an increase in 39-week induction rates and a reduction in CD rates for low-risk nulliparous patients across the United States,” the authors write.

Several authors disclosed ties to the biomedical and medical technology industries.

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