ARRIVE Trial Flaws & The Problems With Elective Inductions

I want to talk about a particular trial that many of these and other providers use as the reference for elective induction of labor, elective induction, because that means there is no clear medical indication. I for one, I'm not sure why. Why this is an issue. Pregnancy is 40 weeks. 70% of patients deliver around their ten days window around the due date. Now I'm thinking there must be a reason why gestational age or pregnancy is 40 weeks. It hasn't changed for thousands of years. Now all of a sudden we want to do something at 39 weeks. So particular study or arrive study first published in the August of 2018 involves 6100 patients and the group was divided into two. Induction of labor versus expectant management Here are a few reasons why I think it is very difficult to apply. The outcome of this study to general population First of all, the population was made up with 24% African-Americans versus perhaps little under 50% which is the general population in the United States. And then only 4% was older than 35 versus current pregnant patients. About 18% are over 35. I think these two facts are really important Now, as far as the outcome is concerned, the primary outcome they wanted to compare was was there any harm done by intervention? And there was no neonatal outcomes were both same for induction versus expectant management but additional outcomes. First of all, cesarean section, this is what people are using. Induction patients 18% expectant management patients. 22%. Again expectant management meaning we let patients go into labor 18 verses 22% where there's a statistical difference between these two numbers. But the issue is even 22% is significantly lower than the national average. So I'm not really sure how this number came about. The other thing is the argument is with this trial eight versus 14% hypertension meaning induced patient group, the percentage of hypertension was only eight and expect the management group was 14%. The problem I have with these two numbers is typically when we look at both high and low risk patients in general, all pregnancies put together the percentage of hypertension is really five to 6%. So why in this group is the percentage high for both induced and expectant management So taking this then to say hey, at 39 weeks elective induction will lower your risk of caesarean section and less likely to develop hypertension I think is erroneous. Because the population in this group is really not reflective of general population. One of the comments from this study was by inducing 28 low risk patients at 39 weeks, we could avoid one cesarean section using same approach. If 14 women with low risk first time moms were supported with continuous labor support, we could avoid one C-section 28 versus 14. I think I would go with 14. I, for one do not believe there's a place for elective induction into 2022. Why pandemic? We are struggling with shortage of medical staff What I see in the hospital that I work out of often one we have shortage of medical staff, particularly labor and delivery nurses. And we are having too many elective inductions who are who are admitted taking up spaces. And then until those patients are delivered there is no room for medically indicated patients who need to be admitted for induction of labor Beyond that, I really believe you don't go against Mother Nature is 40 weeks All pregnancy ends. At some point women will go into labor. It is not my job. I tell patients You know what? Other than the decision you made to get pregnant, that action is what you did. But the rest is reactions. There is no action to be had. Not by the patient. Not by providers.