Arrive trial

[dadaddadaBATMAN]

Hi folks! Visiting from over on the ed su forum (my specialty). A family member is undergoing an elective induction in a couple weeks and asked me about it(since of course elective inductions are an area of expertise for ed docs).

While I was reading up i stumbled across what appears to be a relatively large and well controlled trial suggesting improvements in maternal outcomes (c section rate/hypertensive disorders of pregnancy decrease) and equivalent or slight improvements in neonatal outcomes with elective induction at 39/3 vs expectant management.

link here

https://www.nejm.org/doi/full/10.1056/NEJMoa1800566

there also seem to be a few meta analysis supporting these claims, and smaller studies in the uk.

The acog response seems to be that they are still waiting on full outcome data from the trial and have no recs yet.

I was curious if the community here had any strong thoughts or feelings about the trial, implications for elective induction of labor, etc based on this. Too early to say? Trash trial? New standard of care in 5 years?

if it’s already been hashed out here, please let me know, my forum searching skills are a bit weak but I didn’t see anything

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[anonperson]

Hi folks! Visiting from over on the ed su forum (my specialty). A family member is undergoing an elective induction in a couple weeks and asked me about it(since of course elective inductions are an area of expertise for ed docs).

While I was reading up i stumbled across what appears to be a relatively large and well controlled trial suggesting improvements in maternal outcomes (c section rate/hypertensive disorders of pregnancy decrease) and equivalent or slight improvements in neonatal outcomes with elective induction at 39/3 vs expectant management.

link here

https://www.nejm.org/doi/full/10.1056/NEJMoa1800566

there also seem to be a few meta analysis supporting these claims, and smaller studies in the uk.

The acog response seems to be that they are still waiting on full outcome data from the trial and have no recs yet.

I was curious if the community here had any strong thoughts or feelings about the trial, implications for elective induction of labor, etc based on this. Too early to say? Trash trial? New standard of care in 5 years?

if it’s already been hashed out here, please let me know, my forum searching skills are a bit weak but I didn’t see anything

I offer most patients induction of labor after 39 weeks.

The data from the study is not surprising and only confirms what most OBs have noted anecdotally. Letting pregnancies go on too long leads to more issues--> low fluid which often leads to intolerance of labor, passage of meconium and the potential risk of fetal aspiration etc.

The placenta has a finite lifespan in general. This also bears out with the still birth rate generally creeping up at 38, 39, 40+ weeks.

With our current induction techniques (cytotec, Foley/cook catheter) we can get patients dilated to at least 3 to 4 cm, if not more. If they can't progress after that, it wasn't the induction that caused them to stall, it just wasn't going to happen.

I won't expect ACOG to make any formal recommendations on this in general because theoretically, inductions can be time and labor intensive and this can be an issue regarding resource utilization.

Regardless, ACOG has released guidelines on delivery timing for a variety of conditions and as the population gets fatter/older and generally more unhealthy, there is often a medical indication to do an induction.