Labor induction versus expectant management in low-risk nulliparous women

William A. Grobman, Madeline M. Rice, Uma M. Reddy, Alan T.N. Tita, Robert M. Silver, Gail Mallett, Kim Hill, Elizabeth A. Thom, Yasser Y. El-Sayed, Annette Perez-Delboy, Dwight J. Rouse, George R. Saade, Kim A. Boggess, Suneet P. Chauhan, Jay D. Iams, Edward K. Chien, Brian M. Casey, Ronald S. Gibbs, Sindhu K. Srinivas, Geeta K. SwamyHyagriv N. Simhan, George A. MacOnes

Research output: Contribution to journalArticlepeer-review

208 Scopus citations

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.).

Original languageEnglish (US)
Pages (from-to)513-523
Number of pages11
JournalNew England Journal of Medicine
Volume379
Issue number6
DOIs
StatePublished - Aug 9 2018

ASJC Scopus subject areas

  • Medicine(all)

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