***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 
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    Input: OBJECTIVE To compare patterns of uterine activity from low-dose oxytocin begun immediately or six hours after intracervical placement of prostagl and in E2 ( PGE2 ) gel for the induction of labor . STUDY DESIGN A total of 50 nonlaboring women at term with an unfavorable cervix ( Bishop score < or = 4 ) were given a 0.5-mg dose of PGE2 gel . Each was then r and omized either to be observed or to receive a low dose of oxytocin ( 2 mU/min , increased by 2 mU/min at 30-minute intervals , as necessary ) . After the six-hour observation , the patient was reexamined , and a low dose of oxytocin was either begun or continued . An adequate sample size ( 21 per group ) was calculated for evaluating uterine activity changes . Comparisons were made using chi 2 testing , Student 's t test and analysis of variance , as appropriate . RESULTS There were no differences between the two groups in maternal race , gestational age , predose Bishop score , predose uterine activity or indication for induction . Uterine contractions became more frequent ( P < .01 ) and were judged to be more intense ( P < .02 ) and earlier when oxytocin was used immediately after PGE2 placement . No uterine hyperstimulation or abnormal fetal heart rate pattern was observed that required discontinuation of the oxytocin . The percentages of cases delivering vaginally within 24 , 36 and 48 hours were greater when oxytocin was begun immediately in nullipara ( P < .01 ) . CONCLUSION Low-dose oxytocin may be started immediately after instilling intracervical PGE2 , with shortened time until the onset of adequate contractions A r and omized double-blind trial was conducted over 48 hours comparing the effectiveness of prostagl and in E2 gel administered intracervically with that of demoxytocin buccal tablets for induction of labor in 103 patients with unripe cervical status ( Bishop score 5 or less ) . A statistically significant difference was found in success frequency between the two groups , both on the first day ( 54.7 and 34.0 % , respectively ) and on the second day ( 82.0 and 61.9 % , respectively ; P < .05 ) . Without being matched , variables influencing the course of labor in the two groups were comparable . There was no statistically significant difference in the induction-delivery interval between the two groups during the first and second days of the trial . In both the prostagl and in E2 and the demoxytocin groups , patients who had not gone into labor during the first day showed a statistically significant increment in the Bishop score on the morning of the second day ( 2.4 and 1.3 , respectively ; P < .01 ) . The frequency of instrumental deliveries and cesarean section was the same in both groups ; neither hypertonic uterine contractions nor side effects were observed in any patient . It is concluded that prostagl and in E2 gel administered intracervically is particularly well suited for the induction of labor in patients with unripe cervical status because of its combined contraction-inducing and cervical-ripening properties 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 One hundred thirty-four indigent patients at term who had premature rupture of membranes and a cervix unfavorable for induction of labor ( 80 % effacement or less , 2 cm dilation or less ) were r and omized to compare  expectant with intervention management .  Women with any medical or obstetric condition warranting immediate intervention were excluded from the study . Patients treated expectantly were placed at bed rest and observed for labor or infection . Patients managed by intervention were given oxytocin if labor did not ensue within 12 hours of rupture of the membranes . Patients in the intervention protocol had longer labor ( P<.02 ) and a higher incidence of both cesarean delivery ( P<.05 ) and intraamniotic infection ( P<.05 ) . There was only one case of proven neonatal sepsis , and this occurred in a patient managed by induction of labor . There was no statistically significant difference between groups in mean length of maternal hospitalization THE best way to administer oxytocin for the induction of labour is a matter of dispute . In spite of criticism because of high dosages and unknown rates of absorption the buccal route has its proponents ( Chalmers , Ng and Moorhouse , 1966 ) . Oxytocin is also easily absorbed through the nasal mucosa , and in 1962 Borglin introduced grade d polyethylene tubes through which the patient could blow the solution into the nostril . This method of administration appeared to reduce the risks of overdosage by employing fairly low doses , given at short intervals . In Rorglin ’s ( 1962 ) first report the results of the nasal courses were comparable to those of the intravenous drip . The effectiveness of nasal oxytocin  for the induction of labour has been confirmed by others ( Ovlisen , 1965 ; Miiller and Osler , 1967 ) . The latter authors compared  intravenous , nasal and buccaI administration  in consecutive series of 100 patients each , and found a slightly lower success rate for the nasal than for the two other methods . Complications were few and harmless . In our department buccal oxytocin has been the method of choice for a number of years . As the new nasal administration might offer some advantages , and as no r and omized series had been presented previously , a clinical trial was design ed to compare the two methods . The results of a pilot study , in which we utilized the sequential method , were presented in a preliminary communication ( Bergsjo and Jenssen , 1969 ) , which concluded that there was no difference between the effectiveness of the two methods . However , the possibility of not discovering a true difference by the sequential approach is fairly high ( Bross , 1952 ) . In the present report the number of patients has been increased , and a more appropriate statistical method has been employed in the evaluation of the results A clinical trial was carried out to compare the efficacy and tolerance of two modes of induction of labour : vaginally administered prostagl and in E2 gel vs intravenous perfusion of synthetic oxytocin .  Fifty women with pregnancy at or near term in whom prompt vaginal delivery was clinical ly indicated were divided at r and om into sub-groups of 25 each . Initial dose of PGE2 gel was 1 mg followed by another application of 1 mg or 2 mg 6 hours later in case active labour stage has not been reached . Progressive oxytocin perfusion began with 1 mU/min . , being increased gradually every 20 minutes until efficacious uterine dynamics were attained . Data were recorded on entry of age , parity , gestation age , cervical dilatation , Bishop score , indication for induction . Continuous materno-foetal monitoring was carried out during the induction period . Results were evaluated from induction/delivery time , type of delivery , maternal and foetal condition , and any side-effects which developed . Apart from a higher number of instrumental deliveries in the PGE2 gel series , which was not related to the induction method , there was no significant difference between any of the variables evaluated , both methods producing active labour in approximately 70 % of the patients within 12 hours . The authors stress , however , the convenience , both for patients and hospital staff , of the administration of an intravaginal induction agent over a systemic therapeutic method of induction Summary : We performed a prospect i ve r and omized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes ( PROM ) at term with early induction of labour or expectant management , 126 women with singleton pregnancy , cephalic presentation and gestational duration > 37 weeks , were r and omized either to immediate induction of labour with oxytocin ( Group 1 ) ( n= 52 ) , or conservative management ( Group 2 ) ( n=74 ) . Women who constituted Group 2 were divided into 2 groups . The first group ( Group 2A ) ( n=25 ) included women in whom spontaneous labour did not begin after a waiting period of 24 hours , in which case labour was induced with oxytocin i.e. expectant management . The second group consisted of women ( Group 2B ) ( n=49 ) in whom labour began spontaneously within 24 hours . The base Caesarean section rate was significantly higher in Group 2 ( 28.4 % ) ( p<0.05 ) . The rates of Caesarean section in the Groups 1–2A‐2B were 19.2 % , 60 % , and 12.2 % , respectively for nulliparous and parous women together . The rate of fetal distress was significantly higher in Group 2 ( p<0.05 ) . For determining maternal outcomes , the other parameters such as clinical chorioamnionitis , fever before or during labour , receiving antibiotics before or during labour , postpartum fever , analgesia , anaesthesia did not differ in Groups 1 and 2 . Women in Group 1 went into active labour sooner , had fewer digital vaginal examinations , had a shorter interval between membrane rapture and delivery , and spent less time in the hospital before delivery than those in Group 2 ( p<0.05 ) . Babies in Group 2 were more likely to receive  antibiotics  , and more likely to stay in an intensive care nursery for more than 24 hours , and more likely to receive ventilation after initial resuscitation than those babies in Group 1 . For developing apnoea and hypotonia , there was no significant difference between Groups 1 and 2 . However , for babies in Group 2A there was a significant difference . We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section , compared with a practice of expectant management . Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity Labor characteristics after intracervical application of 0.5 mg prostagl and in ( PG ) E2 gel ( n = 83 ) versus intravenous administration of oxytocin ( n = 82 ) for labor induction were investigated in uncomplicated prolonged pregnancies with unripe cervix . The induction to delivery time as well as the total oxytocin dose were significantly reduced in the PGE2 group ( p < 0.001 ) . Cesarean sections , instrumental deliveries and fetal distress had the same frequency , but the failures of trial were significantly higher in the oxytocin group than in the PGE2 group ( 20.7 vs. 6 % , p < 0.01 ) . Twenty-four percent of women needed a second PGE2 dose , and almost half of the women in the PGE2 group experienced ' spontaneous ' labor . More neonates in the oxytocin group had 5-min Apgar scores < 7 ( p < 0.05 ) . Intracervical PGE2 gel application is superior to intravenous oxytocin in terms of shortening the induction-delivery interval and increasing the frequency of successful vaginal delivery . In addition , it is safe for mother and fetus Premature rupture of the membranes ( PROM ) in otherwise uncomplicated full-term single pregnancies was studied in a prospect i ve r and omized study . Ninety-three women were r and omized to either  induction with oxytocin infusion ( n = 43 ) or expectant management ( n = 50 ) . Twenty-four and 26 respectively were nulliparas . In the induction group , all but 3 were delivered within 24 h from PROM . There were 3 vacuum extraction s ( VE ) , all in nulliparous women . No  cesarean section ( CS ) was performed . In the expectancy group , 23 of 50 were delivered within 24 h. There were 5 VE and 3 CS in nulliparas and 1 VE and 1 CS in paras . The instrumental actions were mainly due to arrest of 1st or 2nd stage labor . The only clinical infections occurred in nulliparas in the expectancy group . Our conclusion is that parous women with PROM can be treated by either induction or expectancy while in nulliparas , induction after some hours ' expectation seems preferable Ninety-one pregnant women with unfavourable cervix ( Bishop score no higher than 6 ) were r and omly allocated to induction of labour with either prostagl and in E2 suppositories 2.5 mg 1 - 2 a day or i.v . oxytocin 4 - 32 mU/min . The induction procedure was carried on for 2 days . For statistical comparison of efficacy , life table 
    Output:
    
Comparison of oxytocin with either intravaginal or intracervical PGE2 reveals that the prostagl and in agents probably increase the chances of achieving vaginal birth within 24 hours .
Oxytocin induction may increase the rate of interventions in labour .