***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: Background The objective of this r and omized prospect i ve study was to compare the efficacy of 50 mcg vaginal misoprostol and 3 mg dinoprostone , administered every nine hours for a maximum of three doses , for elective induction of labor in a specific cohort of nulliparous women with an unfavorable cervix and more than 40 weeks of gestation . Material and Methods One hundred and sixty-three pregnant women with more than 285 days of gestation were recruited and analyzed . The main outcome measures were time from induction to delivery and incidence of vaginal delivery within 12 and 24 hours . Admission rate to the neonatal intensive care unit within 24 hours post delivery was a secondary outcome . Results The induction-delivery interval was significantly lower in the misoprostol group than in the dinoprostone group ( 11.9 h vs. 15.5 h , p < 0.001 ) . With misoprostol , more women delivered within 12 hours ( 57.5 % vs. 32.5 % , p < 0.01 ) and 24 hours ( 98.7 % vs. 91.4 % , p < 0.05 ) , spontaneous rupture of the membranes occurred more frequently ( 38.8 % vs. 20.5 % , p < 0.05 ) , there was less need for  oxytocin augmentation ( 65.8 % vs. 81.5 % , p < 0.05 ) and fewer additional doses were required ( 7.5 % vs. 22 % , p < 0.05 ) . Although not statistically significant , a lower Caesarean section ( CS ) rate was observed with misoprostol ( 7.5 % vs. 13.3 % , p > 0.05 ) but with the disadvantage of higher abnormal fetal heart rate ( FHR ) tracings ( 22.5 % vs. 12 % , p > 0.05 ) . From the misoprostol group more neonates were admitted to the intensive neonatal unit , than from the dinoprostone group ( 13.5 % vs. 4.8 % , p > 0.05 ) . One woman had an unexplained stillbirth following the administration of one dose of dinoprostone . Conclusions Vaginal misoprostol , compared with dinoprostone in the regimens used , is more effective in elective inductions of labor beyond 40 weeks of gestation . Nevertheless , this is at the expense of more abnormal FHR tracings and more admissions to the neonatal unit , indicating that the faster approach is not necessarily the better approach to childbirth Objective To compare vaginal misoprostol with dinoprostone for induction of labour Summary : A prospect i ve r and omised controlled trial was performed to compare the efficacy and safety of intrav‐aginal misoprostol to that of intravaginal dinoprostone when used for cervical priming prior to the induction of labour ; 126 women were recruited to the study and r and omised to receive either intravaginal dinoprostone ( n = 63 ) or misoprostol ( n = 63 ) for cervical priming prior to induction of labour . The mean time from insertion of the priming agent to vaginal delivery was significantly shorter in the misoprostol group ( 925.8 versus 1577.6 minutes ) , the mean duration of the active length of labour was significantly shorter in the misoprostol group ( 353.7 versus 496.8 minutes ) and more women in the misoprostol group delivered in less than 12 hours ( 92 % versus 76.5 % ) The objective of this study was to determine the safety of obstetrics forceps when used under strictly defined criteria compared to vacuum extraction for delivery in the second stage of labour . A r and omised prospect i ve trial was performed on 442 women undergoing instrumental delivery in the second stage . Two hundred and four women were in the forceps group and 238 in the vacuum group . When using forceps traction efforts to deliver the baby were kept to less than three and the head was always delivered in the occipito-anterior position . In the two groups there were no significant difference in the incidence of third-degree perineal tears , post-partum haemorrhage or ruptured uterus . Cervical tears were slightly higher in the forceps group . Babies delivered by vacuum extraction showed a higher incidence of cephalhaematomas . There was no significant difference in babies needing resuscitation at birth , admission to neonatal intensive care unit , stillbirth or neonatal death rates . The failure rate was significantly higher in the vacuum group . The time taken to complete the procedure was significantly less in the forceps group . Forceps deliveries when performed under defined criteria are as safe as vacuum deliveries to the mother with a lesser failure rate and a lower incidence of cephalhaematomas in the neonate compared with vacuum deliveries OBJECTIVE To compare the effectiveness of vaginally administered misoprostol with extra-amniotic prostagl and in F2alpha ( PGF2alpha ) gel for induction of labor . METHOD A r and omized controlled trial , with women allocated to receive either misoprostol 50 microg intra-vaginally or extra-amniotic PGF2alpha gel 5 mg , was conducted in Harare Maternity Hospital . A total of 152 women were admitted for induction of labor with a term singleton , pregnancy and cephalic presentation were recruited . The main outcome was duration of induction . RESULTS There were no differences in the characteristics of women in the two groups at recruitment . In the misoprostol group there was a significantly reduced need for augmentation of labor with oxytocin ( OR=0.36 ; 95 % C.I. 0.17 - 0.73 ) and delivery by cesarean section for failure to progress ( OR=0.11 ; 95 % C.I. 0.00 - 0.88 ) . The risk for duration of induction to vaginal delivery exceeding 12 , 18 or 24 h was reduced by 18 % , 38 % and 68 % , respectively , but only the risk for duration > 24 h was significantly reduced ( OR=0.32 ; 95%C.I. 0.11 - 0.91 ) . The mean duration of induction was shorter in the misoprostol group , 15.2 vs. 23.6 h ( P=0.02 ) . There were no differences in fetal outcome . CONCLUSION Misoprostol 50 microg was associated with less use of oxytocin in labor , a shorter induction to delivery interval and fewer cesarean sections for failure to progress when compared with extra-amniotic PGF2alpha gel BACKGROUND The aims of the present study were to determine whether maternal hyperoxygenation affects human fetal pulmonary circulation and whether there is a gestational age-related response in the fetal pulmonary circulation to maternal hyperoxygenation during the second half of gestation . METHODS AND RESULTS Twenty women between 20 and 26 weeks of gestation and 20 women between 31 and 36 weeks of gestation with normal singleton pregnancies were r and omized to receive either 60 % humidified oxygen or medical compressed air ( room air ) by a face mask . Fetal aortic and pulmonary valve ; ductus arteriosus ( DA ) ; and right ( RPA ) , left ( LPA ) , and distal ( DPA ) pulmonary artery blood velocity waveforms were obtained by Doppler ultrasound before , during , and after maternal administration of either 60 % oxygen or room air . Left and right ventricular cardiac outputs , DA volume blood flow , and RPA and LPA volume blood flows ( Qp ) were calculated . Foramen ovale volume blood flow ( left ventricular cardiac output-Qp ) was estimated . Pulsatility index ( PI ) values of DA , RPA , LPA , and DPA were calculated . Maternal hyperoxygenation did not change any of the measured fetal parameters between 20 and 26 weeks , whereas between 31 and 36 weeks , the PI values of RPA , LPA , and DPA decreased ( P<.0001 ) and the PI of DA increased ( P<.0001 ) . In addition , Qp increased ( P<.001 ) , and DA volume blood flow ( P<.01 ) and foramen ovale volume blood flow ( P<.03 ) decreased . Left and right ventricular cardiac outputs were unchanged . All changes returned to baseline after maternal hyperoxygenation was discontinued . CONCLUSIONS Reactivity of the human fetal pulmonary circulation to maternal hyperoxygenation increases with advancing gestation ; this suggests that fetal pulmonary circulation is under acquired vasoconstriction at least after 31 to 36 weeks of gestation Background Improving maternal health by reducing maternal mortality constitutes the fifth Millennium Development Goal and represents a key public health challenge in the United Republic of Tanzania . In response to the need to evaluate and monitor safe motherhood interventions , this study aims at assessing the coverage of obstetric care according to the Unmet Obstetric Need ( UON ) concept by obtaining information on indications for , and outcomes of , major obstetric interventions . Furthermore , we explore whether this concept can be operationalised at district level . Methods A two year study using the Unmet Obstetric Need concept was carried out in three districts in Tanga Region , Tanzania . Data was collected prospect ively at all four hospitals in the region for every woman undergoing a major obstetric intervention , including indication and outcome . The concept was adapted to address differentials in access to emergency obstetric care between districts and between rural and urban areas . Based upon literature and expert consensus , a threshold of 2 % of all deliveries was used to define the expected minimum requirement of major obstetric interventions performed for absolute maternal indications . Results Protocol s covering 1,260 complicated deliveries were analysed . The percentage of major obstetric interventions carried out in response to an absolute maternal indication was only 71 % ; most major obstetric interventions ( 97 % ) were caesarean sections . The most frequent indication was cephalo-pelvic-disproportion ( 51 % ) . The proportion of major obstetric interventions  for absolute maternal indications performed amongst women living in urban areas was 1.8 % of all deliveries , while in rural areas it was only 0.7 % . The high proportion ( 8.3 % ) of negative maternal outcomes in terms of morbidity and mortality , as well as the high perinatal mortality of 9.1 % ( still birth 6.9 % , dying within 24 hours 1.7 % , dying after 24 hours 0.5 % ) raise concern about the quality of care being provided . Conclusion Based on the 2 % threshold , Tanga Region – with an overall level of major obstetric interventions for absolute maternal indications of 1 % and a caesarean section rate of 1.4 % – has significant unmet obstetric need with a considerable rural-urban disparity . The UON concept was found to be a suitable tool for evaluating and monitoring the coverage of obstetric care at district level Objective To investigate the effect of chronic oxygen therapy in fetuses with absent end diastolic flow in the umbilical artery assessed by doppler analysis at 24–30 weeks of gestation OBJECTIVE Our purpose was to determine the optimal management of pregnancies beyond 41 week 's gestation with a cervix unfavorable for induction . MATERIAL AND METHOD All uncomplicated pregnancies that reached 41 weeks'gestation with a Bishop score of < or = 4 , were r and omly assigned to one of two groups RESULTS The duration of labor was shorter in the group " prépidil " compared with the control group ( P=0.002 ) . Identification of an unfavorable cervix at 41 weeks was unlikely to change by 42 weeks and cervical ripening was required in 40 % cases . There was no significant difference in caesarean section rates . Rates of admission into the neonatal unit and fetal outcomes were similar in the two groups . CONCLUSION Cervical ripening with prostagl and in gel at 41 week 's gestation for uncomplicated singleton pregnancies is safe and should be advocated BACKGROUND Research suggests that fetal exposure to magnesium sulfate before preterm birth might reduce the risk of cerebral palsy . METHODS In this multicenter , placebo-controlled , double-blind trial , we r and omly assigned women at imminent risk for delivery between 24 and 31 weeks of gestation to receive magnesium sulfate , administered intravenously as a 6-g bolus followed by a constant infusion of 2 g per hour , or matching placebo . The primary outcome was the composite of stillbirth or infant death by 1 year of corrected age or moderate or severe cerebral palsy at or beyond 2 years of corrected age . RESULTS A total of 2241 women underwent r and omization . The baseline characteristics were similar in the two groups . Follow-up was achieved for 95.6 % of the children . The rate of the primary outcome was not significantly different in the magnesium sulfate group and the placebo group ( 11.3 % and 11.7 % , respectively ; relative risk , 0.97 ; 95 % confidence interval [ CI ] , 0.77 to 1.23 ) . However , in a prespecified secondary analysis , moderate or severe cerebral palsy occurred significantly less frequently in the magnesium sulfate group ( 1.9 % vs. 3.5 % ; relative risk , 0.55 ; 95 % CI , 0.32 to 0.95 ) . The risk of death did not differ significantly between the groups ( 9.5 % vs. 8.5 % ; relative risk , 1.12 ; 95 % CI , 0.85 to 1.47 ) . No woman had a life-threatening event . CONCLUSIONS Fetal exposure to magnesium sulfate before anticipated early preterm delivery did not reduce the 
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Results We found a paucity of studies reporting statistically significant evidence of impact on perinatal mortality , especially on stillbirths .
Available evidence suggests that operative delivery , especially Caesarean section , contributes to decreased stillbirth rates .
Induction of labour rather than expectant management in post-term pregnancies showed strong evidence of impact , though there was not enough evidence to suggest superior safety for the fetus of any given drug or drugs for induction of labour .
Magnesium sulphate for pre-eclampsia and eclampsia is effective in preventing eclamptic seizures , but studies have not demonstrated impact on perinatal mortality .
There was limited evidence of impact for maternal hyperoxygenation , and concerns remain about maternal safety .
Transcervical amnioinfusion for meconium staining appears promising for low/middle income-country application according to the findings of many small studies , but a large r and omised trial of the intervention had no significant impact on perinatal mortality , suggesting that further studies are needed .
Conclusion Although the global appeal to prioritise access to emergency obstetric care , especially vacuum extraction and Caesarean section , rests largely on observational and population -based data , these interventions are clearly life-saving in many cases of fetal compromise .