ARRIVE

 

Due to the reported increased risks of adverse events in pregnancies that extend beyond 39 weeks, it has been hypothesized that a policy of planned elective induction at 39 weeks could improve outcomes for the infant and the mother. For multiparous patients, especially those with a favorable cervix, it is perhaps easy to justify an elective induction at 39 weeks given the low risk of cesarean section. However, for nulliparous patients, the current evidence, which is derived mainly from retrospective observational studies, does not allow a clear recommendation. Nevertheless, a trend towards an increased rate of elective labor induction in pregnancies at 39 weeks has been reported, which indicates that practitioners are more commonly using elective induction at this gestational age. This occurs even as others caution against routine elective induction prior to 41 weeks due to the reported increased risk of cesarean delivery. Ultimately, a randomized controlled trial is necessary to satisfactorily understand whether elective induction of labor of nulliparous patients at 39 weeks improves neonatal and maternal outcomes.