Implementation of A Randomized Trial of Induction Versus Expectant Management (ARRIVE) in a Community Hospital-Based Obstetric Practice

Background and aimThe randomized controlled trial titled A Randomized Trial of Induction Versus Expectant Management (ARRIVE) evaluated induction at 39 weeks in low-risk nulliparous patients and demonstrated a significant reduction in cesarean sections.The purpose of this study was to assess the maternal and neonatal outcomes before and after the ARRIVE trial implementation of induction at 39 weeks for low-risk nulliparous patients at our community hospital. MethodsA retrospective chart review was completed comparing data one year prior to and after implementation of the ARRIVE trial 39-week induction.Categorical data were evaluated with a chi-square test.Continuous variables were analyzed using a two-sample independent t-test.Statistical significance was set at p<0.05. ResultsA total of 212 patients were included in the pre-ARRIVE trial cohort, and 189 patients were included in the post-ARRIVE trial cohort.Gestational age at which the elective inductions were performed was statistically lower (p=0.0001)post-ARRIVE.There was a statistically significant increase (p=0.01) in pre-delivery length of stay (LOS).The number of inductions also increased after the implementation of the ARRIVE trial (p=0.0001).The C-section rates were not statistically significantly different (p=0.224). ConclusionOur study found that induction rates increased and pre-delivery LOS increased after ARRIVE.Cesarean delivery rates, which increased post-ARRIVE for the whole population and the induction groups only, were not statistically significantly different.Compared to the ARRIVE trial, our results are mixed.