Atwani Rula, Saade George, Kawakita Tetsuya
Department of Obstetrics and Gynecology, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia.
Am J Perinatol. 2025 Feb;42(3):401-408. doi: 10.1055/s-0044-1789018. Epub 2024 Aug 13.
We aim to examine the population-level rates of induction, stillbirth, perinatal mortality, and neonatal death before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial.
This study was a cross-sectional analysis of publicly available U.S. Live Birth data linked with Infant Death and Fetal Death certificate data from National Vital Statistics Online. We limited analyses to nulliparous individuals with singleton pregnancy and cephalic presentation who delivered at 39 weeks or greater. The pre- and post-ARRIVE periods spanned from August 2016 to July 2018, and from January 2019 to December 2020, respectively. Our primary outcome was a stillbirth. Secondary outcomes included induction of labor, perinatal mortality, and neonatal death. Outcomes were compared between the pre- and post-ARRIVE periods. Modified Poisson regression was used to calculate adjusted relative risks (aRRs).
Of 2,817,071 births, there were 1,454,346 births in the pre-ARRIVE period and 1,362,725 in the post-ARRIVE period; there were 1,196 and 1,062 stillbirths in the pre- and post-ARRIVE periods, respectively. Compared to the pre-ARRIVE period, the post-ARRIVE period was not associated with a significant decrease in the risk of stillbirth at 39 weeks or greater (aRR = 0.92 [95% confidence interval (95% CI): 0.85-1.00]) and stillbirth at 40 weeks or greater (aRR = 0.92 [95% CI: 0.82-1.04]). Compared to the pre-ARRIVE trial period, the post-ARRIVE trial was associated with increased rates of induction of labor at 39 weeks (aRR = 1.37 [95% CI: 1.37-1.38]) and 40 weeks (aRR = 1.24 [95% CI: 1.24-1.25]. Similar to stillbirth, there was no significant decrease in the risk of perinatal mortality at 39 weeks or greater or 40 weeks or greater. There was also no statistically significant change in neonatal death rates at 39 weeks or greater or at 40 weeks or greater.
The increase in induction of labor at 39 weeks was not large enough to impact the stillbirth rate at 39 weeks or greater.
· Post-ARRIVE trial, rate of induction of labor increased at 39 and 40 weeks.. · Post-ARRIVE trial, stillbirth and perinatal mortality rates remained unchanged.. · Induction rate rise post-ARRIVE trial did not impact neonatal death rates..
我们旨在研究“ARRIVE（引产与期待管理随机试验）”试验前后引产、死产、围产期死亡率和新生儿死亡率的人群水平发生率。
本研究是一项横断面分析，将公开可用的美国活产数据与来自国家生命统计在线的婴儿死亡和胎儿死亡证书数据相链接。我们将分析限于单胎妊娠、头先露且在39周及以上分娩的初产妇。ARRIVE试验前和试验后时期分别为2016年8月至2018年7月以及2019年1月至2020年12月。我们的主要结局是死产。次要结局包括引产、围产期死亡率和新生儿死亡。对ARRIVE试验前和试验后时期的结局进行比较。采用修正泊松回归计算调整相对风险（aRRs）。
在2,817,071例分娩中，ARRIVE试验前时期有1,454,346例分娩，试验后时期有1,362,725例分娩；ARRIVE试验前和试验后时期的死产分别为1,196例和1,062例。与ARRIVE试验前时期相比，试验后时期在39周及以上孕周的死产风险没有显著降低（aRR = 0.92 [95%置信区间（95%CI）：0.85 - 1.00]），在40周及以上孕周的死产风险也没有显著降低（aRR = 0.92 [95%CI：0.82 - 1.04]）。与ARRIVE试验前时期相比，试验后时期在39周（aRR = 1.37 [95%CI：1.37 - 1.38]）和40周（aRR = 1.24 [95%CI：1.24 - 1.25]）的引产率有所增加。与死产情况类似，在39周及以上或40周及以上孕周的围产期死亡风险没有显著降低。在39周及以上或40周及以上孕周的新生儿死亡率也没有统计学上的显著变化。
39周引产率的增加幅度不足以影响39周及以上孕周的死产率。
· ARRIVE试验后，39周和40周的引产率增加。· ARRIVE试验后，死产和围产期死亡率保持不变。· ARRIVE试验后引产率的上升未影响新生儿死亡率。
