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 Saade, Kim A. Boggess, Suneet P. Chauhan, Jay D. Iams, Edward K. Chien, Brian M. Casey, Ronald S. Gibbs, Sindhu K. Srinivas, Geeta K. Swamy & 2 others Hyagriv N. Simhan, George A. MacOnes

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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

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Induced Labor
National Institute of Child Health and Human Development (U.S.)
Confidence Intervals
Multicenter Studies
Mothers
Newborn Infant
Pregnancy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Grobman, W. A., Rice, M. M., Reddy, U. M., Tita, A. T. N., Silver, R. M., Mallett, G., ... MacOnes, G. A. (2018). Labor induction versus expectant management in low-risk nulliparous women. New England Journal of Medicine, 379(6), 513-523. https://doi.org/10.1056/NEJMoa1800566

Labor induction versus expectant management in low-risk nulliparous women. / Grobman, William A.; Rice, Madeline M.; Reddy, Uma M.; Tita, Alan T.N.; Silver, Robert M.; Mallett, Gail; Hill, Kim; Thom, Elizabeth A.; El-Sayed, Yasser Y.; Perez-Delboy, Annette; Rouse, Dwight J.; Saade, George; Boggess, Kim A.; Chauhan, Suneet P.; Iams, Jay D.; Chien, Edward K.; Casey, Brian M.; Gibbs, Ronald S.; Srinivas, Sindhu K.; Swamy, Geeta K.; Simhan, Hyagriv N.; MacOnes, George A.

In: New England Journal of Medicine, Vol. 379, No. 6, 09.08.2018, p. 513-523.

Research output: Contribution to journalArticle

Grobman, WA, Rice, MM, Reddy, UM, Tita, ATN, Silver, RM, Mallett, G, Hill, K, Thom, EA, El-Sayed, YY, Perez-Delboy, A, Rouse, DJ, Saade, G, Boggess, KA, Chauhan, SP, Iams, JD, Chien, EK, Casey, BM, Gibbs, RS, Srinivas, SK, Swamy, GK, Simhan, HN & MacOnes, GA 2018, 'Labor induction versus expectant management in low-risk nulliparous women', New England Journal of Medicine, vol. 379, no. 6, pp. 513-523. https://doi.org/10.1056/NEJMoa1800566
Grobman WA, Rice MM, Reddy UM, Tita ATN, Silver RM, Mallett G et al. Labor induction versus expectant management in low-risk nulliparous women. New England Journal of Medicine. 2018 Aug 9;379(6):513-523. https://doi.org/10.1056/NEJMoa1800566
Grobman, William A. ; Rice, Madeline M. ; Reddy, Uma M. ; Tita, Alan T.N. ; Silver, Robert M. ; Mallett, Gail ; Hill, Kim ; Thom, Elizabeth A. ; El-Sayed, Yasser Y. ; Perez-Delboy, Annette ; Rouse, Dwight J. ; Saade, George ; Boggess, Kim A. ; Chauhan, Suneet P. ; Iams, Jay D. ; Chien, Edward K. ; Casey, Brian M. ; Gibbs, Ronald S. ; Srinivas, Sindhu K. ; Swamy, Geeta K. ; Simhan, Hyagriv N. ; MacOnes, George A. / Labor induction versus expectant management in low-risk nulliparous women. In: New England Journal of Medicine. 2018 ; Vol. 379, No. 6. pp. 513-523.
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T1 - Labor induction versus expectant management in low-risk nulliparous women

AU - Grobman, William A.

AU - Rice, Madeline M.

AU - Reddy, Uma M.

AU - Tita, Alan T.N.

AU - Silver, Robert M.

AU - Mallett, Gail

AU - Hill, Kim

AU - Thom, Elizabeth A.

AU - El-Sayed, Yasser Y.

AU - Perez-Delboy, Annette

AU - Rouse, Dwight J.

AU - Saade, George

AU - Boggess, Kim A.

AU - Chauhan, Suneet P.

AU - Iams, Jay D.

AU - Chien, Edward K.

AU - Casey, Brian M.

AU - Gibbs, Ronald S.

AU - Srinivas, Sindhu K.

AU - Swamy, Geeta K.

AU - Simhan, Hyagriv N.

AU - MacOnes, George A.

PY - 2018/8/9

Y1 - 2018/8/9

N2 - 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.).

AB - 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.).

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DO - 10.1056/NEJMoa1800566

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JF - New England Journal of Medicine

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