***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Fifty-two women undergoing labor induction and vaginal delivery at term were r and omized between two oxytocin infusion protocol s , involving hourly versus quarter-hourly increases in dose . Potential differences were sought for duration of labor , amount of uterine activity generated , and amount of oxytocin required . Starting at 0.5 mU/minute , oxytocin infusion was increased regularly in small increments every hour or every 15 minutes , according to group assignment . No differences were observed in potentially confounding clinical and demographic factors between the groups , including time to ruptured membranes . There were no clinical ly or statistically significant differences found for the duration of any phase or stage of labor , quantitative assessment of uterine activity , incidence of hyperstimulation , or neonatal outcome . The average dose of oxytocin used was lower in the hourly than in the quarter-hourly protocol ( 4.4 versus 6.7 mU/minute ; P<.005 ) . Significantly fewer patients on the hourly protocol required a maximum infusion rate exceeding 8 mU/minute ( P<.05 ) . More patients on the hourly protocol either had  oxytocin discontinued completely or were maintained at 4 mU/minute or less during the active phase of labor ( P<.05 and P<.001 , respectively ) . We conclude that a slower rate of increase in oxytocin administration via continuous infusion results in no prolongation of any phase of induced labor , while permitting lower infusion rates of the drug Summary . A r and omized prospect i ve controlled trial of an automatic feed‐back controlled oxytocin infusion system ( AIS ) for the induction of labour at term was carried out in three hospitals . In primiparae , a four‐fold reduction in the total dose of oxytocin infused , for the same induction‐delivery interval , was achieved with the AIS compared with st and ard labour ward protocol s relying on midwife control of oxytocin infusion rate . In multiparae , the total dose of oxytocin infused was almost halved when the AIS was used , while the mean duration of labour was increased by 1.6 h to 7.5 h. There were no differences in the mode of delivery or Apgar scores . It is concluded that the AIS is a safe technique for induction of labour . Its use has demonstrated that term labour can be induced efficiently with a mean oxytocin infusion rate between 2–5 and 3 mU/min ( max 8.8 mU/min ) and a total  oxytocin  dose infused of < 5 Abstract A total of 200 women planned for labour induction were r and omised to receive high-dose oxytocin ( 6 mU/min with similar increments every 45 min ) or intermediate-dose oxytocin ( 3 mU/min with similar increments every 45 min ) . Oxytocin solution was prepared with 30 units in 500 ml saline with which the infusion rate in ml/h is numerically equal to oxytocin in mU/min . We observed that the caesarean rate ( 18 % vs 6 % , p = 0.009 ) , contraction abnormalities ( 35 % vs 14 % , p = 0.0005 ) and neonatal bilirubin levels ( 7.99 ± 2.70 vs 6.80 ± 2.65 , p = 0.002 ) were higher with high-dose than with intermediate-dose . The induction – delivery interval ( IDI ) was similar ( 10 h 13 min with high-dose and 11 h 5 min with intermediate-dose ; p = 0.237 , NS ) . Nulliparous women benefited more with intermediate-dose as the caesarean rate was higher with high-dose ( 24.6 % vs 7.9 % , p = 0.011 ) . Although the caesarean rate was higher in multiparous women with high-dose oxytocin , it was statistically not significant ( 5.7 % vs 2.7 % ; p = 0.609 ) . Oxytocin regimens for labour induction are usually high-dose ( 4–6 mU/min ) or low-dose ( 1–1.5 mU/min ) . The former is associated with more contraction abnormalities and the latter with prolonged IDI ; both result in an increased caesarean rate . In order to offset these disadvantages , an intermediate- dose regimen was selected . The increment interval of 45 min was selected in accordance with the pharmacokinetics of oxytocin . We observed a lower caesarean rate when compared with the high-dose regimen , without any increase in the IDI . Hence , we propose that the intermediate-dose oxytocin regimen should be preferred to the high-dose regimen for labour induction OBJECTIVE The objective was to test the safety and efficacy of a pulsatile oxytocin infusion protocol in which a computer-controlled pump adjusts the oxytocin dose rate on the basis of uterine activity . STUDY DESIGN A total of 358 women were enrolled in , and 310 completed , a prospect i ve , r and omized clinical trial comparing three protocol s for the induction of labor with oxytocin : aggressively managed continuous infusion , conservatively managed continuous infusion , and computer-controlled pulsatile infusion . Results were analyzed with Student t and chi 2 " goodness-of-fit " tests . RESULTS Mean doses of oxytocin  in the group receiving pulsed oxytocin were approximately 20 % of the dose rates in the continuous infusion protocol s. All protocol s effectively established labor in the majority of patients , although nulliparous women with unfavorable Bishop scores were more likely to fail to establish labor within a 24-hour period when treated with the aggressive continuous protocol . There were no differences in the rates of cesarean section , hyperstimulation , blood gases , or Apgar scores among the three treatment groups . CONCLUSIONS  Oxytocin  dosage was minimized by use of a computer-controlled pump . With the exception of aggressively managed nulliparous women , there were no differences in the percentages of patients with successful inductions among the three protocol s. The percentage of successful inductions was lower for aggressively managed nulliparous women than for other patient and protocol groups OBJECTIVE To determine whether pulsatile oxytocin infusion improves delivery outcome in women requiring induction or augmentation of labor . STUDY DESIGN Two related r and omized controlled trials undertaken in 2 inner-city United Kingdom university hospitals ( IS RCT N72773405 ; http://www.is rct n.org/ ) . Women were r and omly assigned to a pulsatile or continuous infusion protocol . PRIMARY OUTCOME cesarean section rate ( induction trial ) ; operative delivery rate ( augmentation trial ) . RESULTS For induction , cesarean section rates were similar in women receiving pulsatile ( n = 264 , 38.3 % ) vs continuous infusion of oxytocin ( n = 257 ; 37.7 % ; risk ratio , 1.01 ; 95 % confidence interval , 0.81 - 1.26 ; P = .903 ) , but associated with increased " infusion to time of delivery " intervals ( P < .001 ) in the pulsatile group . For augmentation , pulsatile infusion result ed in higher operative delivery rates ( 70.1 % , n = 251 ) vs continuous infusion ( 62.7 % , n = 249 ; risk ratio , 1.12 ; 95 % confidence interval , 0.99 - 1.27 ; P = .077 ) and increased neonatal morbidity . CONCLUSION For induction , pulsatile infusion of oxytocin is effective , but conferred little clinical benefit . Pulsatile infusion is not recommended for augmentation OBJECTIVE To compare the efficacy and safety of arithmetic and geometric increases in oxytocin infusion dosage during induction of labor . METHODS A total of 120 pregnant women requiring induction of labor at term were r and omly assigned to receive oxytocin at dosages increasing arithmetically or geometrically . Maternal demographics , labor delivery data , and newborn outcomes were compared . The setting was the maternity unit of the Obafemi Awolowo University Teaching Hospitals Complex , Ile-Ife , Nigeria . RESULTS The mean maximum rates of oxytocin delivery needed to achieve adequate uterine contractions were similar in the 2 groups ( 24.66+/-8.34 mU/min vs. 26.38+/-8.77 mU/min , P=0.24 ) . Labor duration was significantly shorter in the geometric progression group ( 496.33+/-54.77 min vs. 421.34+/-63.91 min , P<0.001 ) . There were no differences in the rates of cesarean sections , vaginal deliveries , or uterine hyperstimulation , or in neonatal outcomes . CONCLUSION A geometric rise in the rate of oxytocin infusion delivery reduced the duration of labor without affecting the rates of cesarean sections and uterine hyperstimulation , or newborn outcomes OBJECTIVE Our objective was to compare the safety and efficacy of two accepted oxytocin induction protocol s that differ in oxytocin dose increments . STUDY DESIGN At the Carolinas Medical Center in Charlotte , North Carolina , 151 women with indications for induction of labor were prospect ively r and omized into one of two oxytocin induction protocol s. Safety and efficacy of the two protocol s were analyzed with two-tailed t tests and chi 2 . RESULTS Time from induction to establishment of a regular labor pattern was significantly shorter in the experimental group compared with the traditional group ( p = 0.03 ) . However , no significant difference was seen from onset of induction to time of delivery . Incidences of hyperstimulation were not significantly different between the two protocol s , but there was a trend toward a higher incidence of fetal heart rate changes in the experimental group ( p = 0.08 ) . CONCLUSION These data suggest that induction with larger dose increments will shorten time to adequate labor without an associated increase in uterine hyperstimulation or poor neonatal outcome . The differences in heart rate changes are concerning and merit further investigation . If confirmed by further studies , an increased risk of cord compression could outweigh the benefit of a faster onset of contractions OBJECTIVE To investigate in women of low parity ( para 1 , 2 or 3 ) whether induction of labor using a regimen of intravenous oxytocin , increasing incrementally at 30-min intervals is safer than one increasing at 15-min intervals . METHOD Two hundred and forty-five women of low parity requiring induction of labor by infusion of oxytocin  were r and omly allocated to incremental increases at 30-min intervals ( 123 women ) as experimental group or 15-min intervals ( 122 women ) as the control group . In both groups forewater amniotomy was performed synchronously with oxytocin infusion using the allocated regimen . RESULTS The 30-min incremental regimen result ed in less precipitate labor , uterine hyperstimulation and a reduced length of stay in hospital . The induction delivery interval was longer with the experimental group which also had less occurrence of postpartum hemorrhage , perineal tears and puerperal pyrexia . CONCLUSION Oxytocin infusion regimen with 30 min incremental increases is safer than the regimen with 15-min incremental increases The number of  cesarean births for dystocia has increased dramatically in the United States . Central to the management of dystocia is correction of ineffective labor by oxytocin administration , and contemporary obstetric practice is to stimulate labor with a low-dose oxytocin regimen . We prospect ively compared a low-dose oxytocin regimen ( 1-mU/ minute dosage increments ) with a high-dose regimen ( 6-mll/ minute dosage increments ) in 2788 consecutive singleton cephalic pregnancies . The low-dose regimen was used first for 5 months in 1251 pregnancies , and the high-dose regimen in 1537 pregnancies during the subsequent 5 months . Indications for oxytocin stimulation were divided into augmentation ( N=1676 ) and induction ( N=1112 ) . Labor stimulation was more than 3 hours shorter ( P<.0001 ) with the high-dose oxytocin regimen and associated with a reduction in neonatal sepsis ( 0.2 versus 1.3 % ; P<.01 ) . Uterine hyperstimulation was more common ( 55 versus 42 % ; P<.0001 ) with the high-dose regimen , but no adverse fetal effects were observed . High-dose augmentation result ed in significantly fewer forceps deliveries ( 12 versus 16 % ; P=.03 ) and fewer cesareans for dystocia ( 9 versus 12 % ; P=.04 ) . Similarly , failed induction was less frequent with high-dose compared with low-dose oxytocin ( 14 versus 19 % ; P=.05 ) . Although the high-dose induction regimen was associated with a significantly increased cesarean incidence for fetal distress ( 6 versus 3 % ; P=.05 ) , the incidence of umbilical artery cord blood acidemia was not increased in this subset . Induction of labor with high-dose oxytocin is problematic because of risk-benefit considerations . Although induction failed less frequently with the high-dose regimen , cesarean for fetal distress was performed more frequently . In contrast , high-dose oxytocin to augment ineffective spontaneous labor minimized the number of cesareans done for dystocia OBJECTIVE To test the hypothesis that high-dose oxytocin , when used in a masked fashion , would result in shorter labors and less need for cesarean delivery . METHODS We conducted r and omized , double-masked trials of high-dose compared with low-dose oxytocin for augmentation and induction of labor . Patients were r 
    Output:
    
AUTHORS ' CONCLUSIONS The findings of our review do not provide evidence that high-dose oxytocin increases either vaginal delivery within 24 hours or the caesarean section rate .
There is no significant decrease in induction to delivery time at meta- analysis but these results may be confounded by poor quality trials .
High-dose oxytocin was shown to increase the rate of uterine hyperstimulation but the effects of this are not clear .