***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: OBJECTIVE To assess the ability of mifepristone to prime the cervix adequately and induce labor in pregnant women at term ; and when mifepristone alone proves insufficient , to determine whether oral misoprostol taken 48 h following mifepristone administration is effective in inducing labor . METHODS In this prospect i ve study 50 pregnant women at term with an unfavorable cervix were given 400 mg of mifepristone orally and allowed to return home . If labor did not start within 48 h , the women were admitted and induction was continued with 50 mug of misoprostol , a prostagl and in ( PG ) E1 analogue , taken orally every 4 h. The 50 controls , who were matched prospect ively for parity and pregnancy duration , underwent labor induction according to the routine administration of 3-mg tablets of PGE2 vaginally . RESULTS In the study group , 66 % of the women entered labor spontaneously or had a sufficiently ripened cervix within 48 h of taking mifepristone . However , there was no difference in time between prostagl and in administration and delivery between the control group and the 34 % of women who required misoprostol in the study group . In the study group , the cesarean section rate was significantly lower among the women whose labor was induced with mifepristone alone than among those who required misoprostol . There were no differences overall in obstetric or neonatal outcomes between the study and control groups . CONCLUSIONS In this pilot sample , 400 mg of mifepristone was effective in inducing cervical changes and labor . Although there were no adverse effects using oral misoprostol in combination with mifepristone , labor was more difficult to induce in the women who did not respond to mifepristone alone , and these women had a higher operative delivery rate The value of gentle , unilateral breast stimulation in the ripening of cervix and induction of labour was studied . Three hundred patients with uncomplicated term pregnancies , ( 38 - 42 weeks ) were recruited into the study , consisting of three separate r and omised double blind prospect i ve trials . The first trial was to evaluate the effectiveness of breast stimulation  in ripening the cervices of 200 term primigravid patients . There was a mean change of 3.90 + /- 2.39 points in cervical score among the study group compared to 0.50 + /- 0.67 among the control group . Thirty-three per cent of the study group went into labour when compared with 4 % among the control group . In a second study of cross-over trial involving 78 of the original 200 patients , the study ( ex-control ) group had a mean change in cervical score of 3.84 + /- 2.24 when compared with the control ( ex- study ) group , ( 1.43 + /- 1.08 ) . In a third study involving 100 multiparous patients , a mean change in cervical score of 2.74 + /- 1.16 was observed in the study group when compared with the control group , 0.92 + /- 1.07 . Forty-six per cent of the patients went into labour compared with 12 % in the control group . All findings were highly significant and there were no maternal or fetal side-effects . The study confirmed the efficacy of breast stimulation in cervical ripening and induction of labour OBJECTIVE To determine the safety and effectiveness of self-administered treatment with isosorbide mononitrate ( IMN ) for cervical ripening in Indian women with post date d pregnancies . METHODS A r and omized , placebo-controlled study was conducted with 200 women with post date d pregnancies and unfavorable cervices who self-administered vaginally either 2 40-mg tablets of IMN or 2 40-mg tablets of pyridoxine as placebo prior to admission for induction of labor . The main outcome variables were change in Bishop score , time from admission to delivery , and presence or absence of fetal and maternal morbidity . RESULTS The Bishop score was significantly improved 24 hours after initiation of the outpatient IMN treatment ( P<0.001 ) and the needs for further cervical ripening and oxytocin infusion were less in the study than in the control group ( P<0.001 and P=0.008 ) . The time from admission to delivery was also less ( P<0.001 ) . Moreover , the IMN treatment had no major adverse maternal or fetal effects . The vast majority of women in both groups were either satisfied or very satisfied with the outpatient treatment . CONCLUSION The self-administration , at home , of isosorbide mononitrate leads to a safe and effective cervical ripening prior to labor induction in women with post date d pregnancies . CTRI Registration No.:CTRI/2011/091/000121 Two hundred consecutive women with uncomplicated pregnancies , at or within 4 days of their expected date of confinement , were prospect ively r and omized into 2 groups . One group had expectant management , with twice weekly surveillance tests , while the other group had 3 mg of vaginal prostagl and in E2 as outpatient treatment . There were 104 women in the expectant group and 70 in the induction group ( 26 women allocated to induction preferred no treatment ) . The average number of days to delivery was 1.6 in the induction group and 5.2 in the expectant group ( p < 0.001 ) . While meconium was much less frequent in the induction group ( p < 0.002 ) , all other outcome measures , including cesarean section rates , incidence of macrosomia , and Apgar scores , were similar in the two groups In a prospect i ve r and omized study , pregnancies with unfavorable cervix and well established gestational age of at least 42 weeks were selected for management by either antepartum fetal testing or prostagl and in gel induction of labor . Of the 108 pregnancies studied , 57 ( 53 % ) had labor induced and 51 ( 47 % ) continued without intervention . Comparison of the two groups showed no difference in meconium staining , fetal distress , length of first stage of labor , the need for intervention , or the mode of delivery . In terms of Apgar score the neonatal outcome was not significantly different but a greater proportion of the babies ( 7.8 % versus 1.8 % ) in the noninduced group required intubation . Our data show that there is no particular advantage in letting the pregnancy go beyond 42 completed weeks of gestation especially if prostagl and in is available for induction of labor OBJECTIVE To determine whether outpatient administration of intracervical prostagl and in ( PG ) E2 gel decreases the interval to delivery and duration of labor . METHODS A r and omized , double-blind , placebo-controlled trial compared the intracervical placement of 0.5 mg PGE2 gel with placebo in 61 pregnant women at 38 weeks ' or greater gestation with Bishop scores less than 9 .  Transvaginal cervical length , fetal fibronectin , and Bishop score were assessed before gel placement . Subjects were then allowed to go into spontaneous labor unless an indication for induction developed . RESULTS Thirty women were assigned to PGE2 and 31 to placebo . There were no significant demographic differences between the groups and there were no differences in cervical length , fetal fibronectin status , or Bishop scores . Fifteen women in the PGE2 group and five in the placebo group went into labor and delivered within the first 2 days after gel placement ( P = .007 ) . The median interval to delivery was significantly shorter in the PGE2 group , at 2.5 days , compared with placebo , at 7 days ( P = .02 ) . Nulliparas in the PGE2 group had a median interval to delivery of 2 days , compared with 7 days for nulliparas receiving  placebo  ( P = .03 ) . Active phases of labor were significantly shorter in the PGE2 group and for women with a negative fetal fibronectin test who received PGE2 . CONCLUSION Outpatient administration of intracervical PGE2 gel shortened intervals to delivery and shortened labor Objective To compare the effects of 50 mg or 200 mg of oral mifepristone with placebo on cervical ripening and induction of labor in primigravid women at term with unfavorable cervices . Methods This was a double-blind study in which 80 primigravidae at term with a modified Bishop score of 4 or less were r and omly assigned to one of three treatment groups . They were assessed at 24-hour intervals for 72 hours , after which labor was induced if it had not occurred spon-taneously . Results Two hundred milligrams of mifepristone result ed in a favorable cervix ( with a Bishop score greater than 6 or in spontaneous labor ) in significantly more women than placebo ( P = .01 ) . An improvement in cervical ripening was seen in the group given 50 mg of mifepristone , but this was not statistically significant . There were more cesarean deliveries performed for fetal distress in the group treated with 200 mg of mifepristone than placebo , but this was not statistically significant and was not associated with any differences between groups in terms of neonatal outcome . Conclusion Mifepristone , a progesterone antagonist , is known to cause softening and dilation of the human early pregnant cervix and an increase in uterine activity . It is theoretically attractive for use as an adjunct in cervical priming and labor induction . In this study , 200 mg of mifepristone was significantly more likely to result in a favorable cervix than placebo Background There is increasing interest in carrying out pre-induction cervical ripening on an outpatient basis . However , there are concerns about the use of prostagl and ins , the agents commonly used in hospital setting s for this indication , because prostagl and ins induce uterine contractions that may lead to fetal hypoxia . Indeed , in a recent study we demonstrated abnormalities in 9 % of fetal heart rate tracings performed following prostagl and in induced cervical ripening at term . In contrast , we confirmed in the same study that isosorbide mononitrate ( IMN ) ( administered on an inpatient basis ) was both effective in inducing cervical ripening at term , and was associated with no associated fetal heart rate abnormalities . Methods / design The aim of this study is to determine whether IMN self administered by women on an outpatient basis improves the process of induction of labour . Specifically , we hypothesise that the use of outpatient IMN will result in a shorter inpatient stay before delivery , decreased costs to the health service and greater maternal satisfaction with ripening and induction of labour , compared with placebo treatment . In the study described here ( the " IMOP " study ) , women scheduled for induction of labour at term , and who require pre-induction cervical ripening will be r and omised to self-administer at home either IMN 40 mg , or a placebo , each vaginally , at 48 hours , 32 hours and 16 hours before scheduled hospital admission . After admission to hospital , treatment will revert to the usual induction of labour protocol . We will compare the primary outcomes of the elapsed time interval from hospital admission to vaginal delivery , the costs to the health service of induction of labour , and women 's experience of induction of labour in the two groups . Discussion This trial will provide evidence on the efficacy of outpatient IMN for pre-induction cervical ripening at term . We will study a formulation of IMN which is cheap and widely available . If the treatment is effective , acceptable to women , and cost effective , it could be implemented into obstetric practice worldwide . Trial registration The trial has been registered on the International St and ard R and omised Controlled Trial Number Register ( IS RCT N ) and given the registration number ISRTN39772441 OBJECTIVE Our purpose was to determine whether a protocol for outpatient induction is safe and effective for initiating labor . STUDY DESIGN A r and omized , double-blind , placebo-controlled trial was performed with 100 low-risk patients having well- date d pregnancies . Women with a Bishop score < or = 6 at 38 to 40 weeks ' gestation were administered either 2 mg of intravaginal prostagl and in E2 gel or placebo for 5 consecutive days as out patients while undergoing fetal monitoring . RESULTS The median interval from r and omization to delivery was 4 days in the prostagl and in E2 group ( range 0 to 28 days ) versus 10 days in the placebo group ( range 0 to 26 days , p = 0.002 ) . Twenty-seven of 50 patients ( 54 % ) in the prostagl and in E2 group were admitted for labor during the dosing interval compared with 10 placebo-treated patients ( 20 % , p = 0.001 ) . The mean gestational age at delivery was significantly reduced in the treatment group ( 39.9 + /- 1.0 weeks vs 40.5 + /- 0.99 weeks , p = 0.003 ) as was the incidence of post date s pregnancy ( 40 % vs 66 % , p = 0.016 ) . Hyperstimulation was observed in one prostagl and in E2-treated patient , but no intervention was required . CONCLUSIONS Outpatient low-dose prostagl and in E2 gel administration is effective for initiating labor in patients with an unfavorable cervix and appears safe if performed with adequate monitoring CONTEXT Despite wide use of castor oil to initiate labor , the obstetric literature contains few references to this botanical laxative . Derived from the castor plant Ricinus communis , castor oil may possess properties that are useful in post-term pregnancies . OBJECTIVE To evaluate the relationship between the use of castor oil and the onset of labor . DESIGN Prospect i ve evaluation . SETTING A community hospital in Brooklyn , NY . PATIENTS A total of  
    Output:
    
Induction of labour in outpatient setting s appears feasible and important adverse events seem rare , however , in general there is insufficient evidence to detect differences .
There was no strong evidence that agents used to induce labour in outpatient setting s had an impact ( positive or negative ) on maternal or neonatal health .
There was some evidence that compared to placebo or no treatment , induction agents administered on an outpatient basis reduced the need for further interventions to induce labour , and shortened the interval from intervention to birth .