Prophylactic induction

Abstract

The SMFM Statement1Society of Maternal–Fetal (SMFM) Publications CommitteeSMFM statement on elective induction of labor in low-risk nulliparous women at term: the ARRIVE trial.Am J Obstet Gynecol. 2019; 221: B2-B4Abstract Full Text Full Text PDF Scopus (30) Google Scholar and the ARRIVE2Grobman W.A. Rice M.M. Reddy U.M. et al.Labor induction versus expectant management for low-risk nulliparpous women.N Engl J Med. 2018; 379: 513-523Crossref PubMed Scopus (309) Google Scholar trial are changing our concept of what constitutes an elective induction of labor (IOL). Elective IOL has a negative connotation, as it is performed with no medical benefits in mind and may be for the convenience of the patient, the practitioner, or both. It is appropriately given the lowest priority on the induction schedule. The ARRIVE trial’s findings of reduced primary cesarean delivery and fewer hypertensive disorders of pregnancy now allow us to describe and designate these inductions as prophylactic. The prophylactic IOLs should occupy a higher priority than elective IOLs. Most Labor and Delivery (L&D) units presently have limited slots for induction. When the benefits are presented to low-risk nulliparas, the women who choose to be induced should be accommodated. The movement toward delivery between 39 and 40 weeks seems to be gaining momentum,3Greene M.F. Choices in managing full-term pregnancy.N Engl J Med. 2018; 379: 580-581Crossref PubMed Scopus (9) Google Scholar,4Grobman W.A. Caughey A.B. Elective induction of labor at 39 weeks compared with expectant management: a meta analysis of cohort studies.Am J Obstet Gynecol. 2019; 221: 304-310Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar and L&D units should devise ways to handle this new reality. At this time, when nulliparous women meet the ARRIVE criteria they should be able to schedule their prophylactic induction. SMFM Statement on Elective Induction of Labor in Low-Risk Nulliparous Women at Term: the ARRIVE TrialAmerican Journal of Obstetrics & GynecologyVol. 221Issue 1PreviewA Randomized Trial of Induction Versus Expectant Management (ARRIVE) was conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network from March 2014 to August 2017.This large multicenter, unmasked, randomized controlled trial was performed to test the hypothesis that elective IOL at 39 weeks of gestation, compared with expectant management among low-risk nulliparous women, reduces the risk of a composite outcome of perinatal death or severe neonatal morbidity. Full-Text PDF