BACKGROUND AND PURPOSE:

• Po et al. (AJOG, 2019) sought to predict the potential reduction in stillbirths with the adoption of the ARRIVE protocol of induction at 39 weeks for nulliparous, low risk women

METHODS:

• Retrospective study
• Data sources
  • US vital statistics data from Live Birth and Fetal Death certificates (2014 to 2016)
  • Singleton deliveries ≥39 weeks | No preexisting maternal risk factors
  • Exclusions: Pregestational diabetes | Chronic hypertension | Scheduled cesarean delivery | Unknown delivery method | Unknown gestational age
• Study design
  • Researchers determined the number of stillbirths in low risk women from 39 weeks on
  • Assumption: Not all stillbirths in the 39th week would be prevented by induction in the 39th week as some stillbirths would have occurred in the 39^th week prior to delivery  
    • Authors assumed that half of 39-week stillbirths could be prevented by induction
• Primary outcome
  • Determine stillbirth rate at ≥39 weeks in singleton, low-risk pregnancies and predict potential impact of the 39-week induction policy
  • Calculate number of inductions required to prevent 1 stillbirth based on the above results

RESULTS:

• 12,098,773 total births | 155,753 stillbirths
• At ≥39 weeks, 3874 stillbirths were recorded
  • Low risk: 3584 stillbirths | Stillbirth rate of 0.60 per 1000 births
• The total number of preventable stillbirths during the 3-year study period was 2650 (883 stillbirths per year)
• Using ‘conservative’ assumption that only 50% of 39-week stillbirths would be prevented by 39-week induction
  • Total preventable stillbirths with 39 week policy: 2650 (approximately 883 per year)
  • 1675 inductions would be required to prevent 1 stillbirth

CONCLUSION:

• Implementing the ARRIVE protocol could potentially prevent 883 stillbirths per year in the US; however, 1675 inductions would be required to prevent one stillbirth
• Authors state that these results could help aid clinicians and patients with decision making

Learn More – Primary Sources:

The impact of induction of labor at 39 weeks in low-risk women on the incidence of stillbirth

Related ObG Topics:

The ARRIVE Trial and Professional Guidance: Elective 39 Week Induction to Reduce the Risk of Cesarean Section

Induction vs Expectant Management At and Beyond Term – the Cochrane Review

Low-Risk Multiparous Women: Induction of Labor at 39 Weeks or Expectant Management?

Does Elective Induction of Labor at 39 Weeks Gestation Lead to Improved Maternal and Newborn Outcomes?