***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: Two hundred and seventy-four women admitted for delivery of singleton infants were studied for the effects of a preparatory enema on faecal contamination , duration of labour , and the incidence of infection in the newborn .  Altogether 149 of the women were given an enema ( controls ) and 125 were not . The two groups showed no significant difference in the degree of faecal contamination during the first and second stages of labour , and the incidences of gross contamination were similar . Contamination after an enema was especially difficult to control , since it was more likely to be fluid . Seven neonates in each group showed evidence of infection , bowel organisms being isolated from four in the no-enema group and two in the control group . Duration s of labour , though not strictly comparable , were similar in the two groups . The findings suggest that when preparing for normal labour the enema should be reserved for women who have not had their bowels open in the past 24 hours and have an obviously loaded rectum on initial pelvic examination The effect of a soap enema on the progress of labour was studied in 160 women admitted for delivery in Esigodini District Hospital . The study was set up as a 1:1 r and omised case control study in 200 women . It was changed to a 1:3 case control study after 82 subjects had been studied , when it became apparent that the midwives were no longer willing to follow the study protocol . Forty women received an enema and 120 did not . Two focus group discussion s were held with 16 women who had an enema . The 12 hospital midwives were asked to give their opinion on enemas . Focus group discussion s were also held with 28 traditional midwives . Dilation of the cervix was 2.19 cm/hour in the non-enema group ( 95pc confidence interval 1.86 - 2.52 ) and 2.00 cm/hour in the enema group ( 95pc confidence interval 1.38 - 2.62 ) . The difference is not significant ( t-test : p-value = 0.58 ) . Pregnant women did not like enemas , midwives preferred not to administer them and were not concerned with contamination during delivery . Traditional midwives do not use enemas in labouring women and consider the possible contamination as normal . It is concluded that there is no benefit from routine enemas in labour Abstract Background Enemas are used during labour in obstetric setting s with the belief that they reduce puerperal and neonatal infections , shorten labour duration , and make delivery cleaner for attending personnel . However , a systematic review of the literature found insufficient evidence to support the use of enemas . The objective of this RCT was to address an identified knowledge gap by determining the effect of routine enemas used during the first stage of labour on puerperal and neonatal infection rates . Methods Design : RCT ( r and omised controlled trial ; r and omized clinical trial ) . Outcomes : Clinical diagnosis of maternal or neonatal infections , labour duration , delivery types , episiotomy rates , and prescription of antibiotics Setting : Tertiary care referral hospital at the Javeriana University ( Bogotá , Colombia ) that attended 3170 births during study period with a caesarean section rate of 26 % . Participants : 443 women admitted for delivery to the obstetrics service ( February 1997 to February 1998 ) and followed for a month after delivery . Inclusion criteria were women with : low risk pregnancy and expected to remain in Bogotá during follow up ; gestational age ≥ 36 weeks ; no pelvic or systemic bacterial infection ; intact membranes ; cervix dilatation ≤7 cm . Intervention : 1 litre saline enema , versus no enema , allocated following a block r and om allocation sequence and using sealed opaque envelopes . Results Allocation provided balanced groups and 86 % of the participants were followed up for one month . The overall infection rate for newborns was 21 % , and 18 % for women . We found no significant differences in puerperal or neonatal infection rates ( Puerperal infection : 41/190 [ 22 % ] with enema v 26/182 [ 14 % ] without enema ; RR 0.66 CI 95 % : 0.43 to 1.03 ; neonatal infection 38/191 [ 20 % ] with enema v 40/179 [ 22 % ] without enema ; RR 1.12 , 95 % CI 95 % 0.76 to 1.66 ) , and median labour time was similar between groups ( 515 min . with enema v 585 min . without enema ; P = 0.24 ) . Enemas did n't significantly change episiorraphy dehiscence rates ( 21/182 [ 12 % ] with enema v 32/190 [ 17 % ] without enema ; P = 0.30 ) . Conclusion This RCT found no evidence to support routine use of enemas during labour . Although these results can not rule out a small clinical effect , it seems unlikely that enemas will improve maternal and neonatal outcomes and provide an overall benefit OBJECTIVE To compare the maternal and neonatal outcomes between enema and no-enema in pregnant women on admission in labor . MATERIAL AND METHOD One thous and and one hundred term pregnant women with labor pain were selected r and omly on admission to be assigned into two groups at Rajavithi Hospital from 1 February 2002 to 15 June 2002 . Five -hundred and thirty-nine cases received enema and five-hundred and sixty one cases received noenema .  Seventy three women ( 39 and 34 cases from the enema and no-enema groups , respectively ) were excluded because of cesarean section due to obstetric indications . Five hundred cases received enema and five-hundred and twenty -seven cases received no-enema . All cases were delivered vaginally . RESULTS There was no statistical significant difference between the two groups with regards to maternal age , gestational age , gravidity , parity , mode of delivery , type of episiotomy and degree of perineal tear . Fecal contamination rate during the second stage of labor was significantly higher in the women who received no-enema ( 34.9 % ) in comparision with those receiving enema ( 22.8 % ( p < 0.001 ) . No neonatal infection occurred in both groups . Duration of labor was significantly longer in the women who received no-enema ( 459.8 min ) compared with those who received enema ( 409.4 min ) ( p < 0.001 ) . CONCLUSION No-enema methods on admission in labor had significantly more increase infecal contamination in the second stage of labor and longer duration of labor than the enema method But there was no difference in perineal wound infection and neonatal infection between both groups BACKGROUND Intervention rates in maternity practice s vary considerably across Canadian provinces and territories . The objective of this study was to describe the use of routine interventions and practice s in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System . Rates of interventions and practice s are considered in the light of current evidence and both Canadian and international recommendations . METHODS A sample of 8,244 estimated eligible women was identified from a r and omly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory . Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada . Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old ( 9 - 14 mo in the territories ) . Completed responses were obtained from 6,421 women ( 78 % ) . RESULTS Women frequently reported electronic fetal monitoring , a health care practitioner starting or speeding up their labor ( or trying to do so ) , epidural anesthesia , episiotomy , and a supine position for birth . Some women also reported pubic or perineal shaves , enemas , and pushing on the top of their abdomen . CONCLUSIONS Several practice s and interventions were commonly reported in labor and birth in Canada , although evidence and Canadian and international guidelines recommend against their routine use . Practice s not recommended for use at all , such as shaving , were also reported While taking an enema to induce labor is a controversial issue worldwide , in Taiwan it remains a routine procedure in many hospitals in preparation for birth . Episiotomy is also a prevalent procedure performed during the birthing process . Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and , therefore , are justified as a routine procedure . This study compared the neonatal infection rates , times to appearance of fetal head , times to first post-labor bowel movement , and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not . A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned r and omly into one of two groups for a six-month period . The first group ( 264 subjects ) received routine enema procedures prior to delivery in the first 6 months . The second group ( 270 subjects ) did not receive enemas . Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance . While labor duration was the same for the two groups in the first and third stages of labor , the enema group experienced a relatively shorter second stage . No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates . The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity . However , limitations of the research design suggest that a r and omized clinical trial be adopted in the future to explore further the scientific validity of study results 
    Output:
    
The evidence provided by the three included RCTs shows that enemas do not have a significant effect on infection rates such as perineal wound infection or other neonatal infections and women 's satisfaction .