***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: CONTEXT Half of all cases of cerebral palsy ( CP ) occur in term infants , for whom risk factors have not been clearly defined . Recent studies suggest a possible role of chorioamnionitis . OBJECTIVE To determine whether clinical chorioamnionitis increases the risk of CP in term and near-term infants . DESIGN , SETTING , AND PATIENTS Case-control study nested within a cohort of 231 582 singleton infants born at 36 or more weeks ' gestation between January 1 , 1991 , and December 31 , 1998 , in the Kaiser Permanente Medical Care Program , a managed care organization providing care for more than 3 million residents of northern California . Case patients were identified from electronic records and confirmed by chart review by a child neurologist , and comprised all children with moderate to severe spastic or dyskinetic CP not due to postnatal brain injury or developmental abnormalities ( n = 109 ) . Controls ( n = 218 ) were r and omly selected from the study population . MAIN OUTCOME MEASURE Association between clinical chorioamnionitis and increased risk of CP in term and near-term infants  . RESULTS Most CP cases had hemiparesis ( 40 % ) or quadriparesis ( 38 % ) ; 87 % had been diagnosed by a neurologist and 83 % had undergone neuroimaging .  Chorioamnionitis  , considered present if a treating physician made a diagnosis of chorioamnionitis or endometritis clinical ly , was noted in 14 % of cases and 4 % of controls ( odds ratio [ OR ] , 3.8 ; 95 % confidence interval [ CI ] , 1.5 - 10.1 ; P = .001 ) . Independent risk factors identified in multiple logistic regression included chorioamnionitis ( OR , 4.1 ; 95 % CI , 1.6 - 10.1 ) , intrauterine growth restriction ( OR , 4.0 ; 95 % CI , 1.3 - 12.0 ) , maternal black ethnicity ( OR , 3.6 ; 95 % CI , 1.4 - 9.3 ) , maternal age older than 25 years ( OR , 2.6 ; 95 % CI , 1.3 - 5.2 ) , and nulliparity ( OR , 1.8 ; 95 % CI , 1.0 - 3.0 ) . The population -attributable fraction of chorioamnionitis for CP is 11 % . CONCLUSION Our data suggest that chorioamnionitis is an independent risk factor for CP among term and near-term infants BACKGROUND As the interval between rupture of the fetal membranes at term and delivery increases , so may the risk of fetal and maternal infection . It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another . METHODS We studied 5041 women with prelabor rupture of the membranes at term . The women were r and omly assigned to induction of labor with intravenous oxytocin ; induction of labor with vaginal prostagl and in E2 gel ; or expectant management for up to four days , with labor induced with either intravenous oxytocin or vaginal prostagl and in E2 gel if complications developed . The primary outcome was neonatal infection . Secondary outcomes were the need for cesarean section and women 's evaluations of their treatment . RESULTS The rates of neonatal infection and cesarean section were not significantly different among the study groups . The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group , 3.0 percent for the induction-with-prostagl and in group , 2.8 percent for the expectant-management ( oxytocin ) group , and 2.7 percent for the expectant-management ( prostagl and in ) group . The rates of cesarean section ranged from 9.6 to 10.9 percent . Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management ( oxytocin ) group ( 4.0 percent vs. 8.6 percent , P<0.001 ) , as was postpartum fever ( 1.9 percent vs. 3.6 percent , P=0.008 ) . Women in the induction groups were less likely to say they liked " nothing " about their treatment than those in the expectant-management groups . CONCLUSIONS In women with prelabor rupture of the membranes at term , induction of labor with oxytocin or prostagl and in E2 and expectant management result in similar rates of neonatal infection and cesarean section . Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management . Women view induction of labor more positively than expectant management We analysed 113 reports published in 1980 in a sample of medical journals to relate features of study design to the magnitude of gains attributed to new therapies over old . Overall we rated 87 per cent of new therapies as improvements over st and ard therapies . The mean gain ( measured by the Mann-Whitney statistic ) was relatively constant across study design s , except for non-r and omized controlled trials with sequential assignment to therapy , which showed a significantly higher likelihood that a patient would do better on the innovation than on st and ard therapy ( p = 0.004 ) . R and omized controlled trials that did not use a double-blind design had a higher likelihood of showing a gain for the innovation than did double-blind trials ( p = 0.02 ) . Any evaluation of an innovation may include both bias and the true efficacy of the new therapy , therefore we may consider making adjustments for the average bias associated with a study design . When interpreting an evaluation of a new therapy , readers should consider the impact of the following average adjustments to the Mann-Whitney statistic : for trials with non-r and om sequential assignment a decrease of 0.15 , for non-double-blind r and omized controlled trials a decrease of 0.11 Objective To compare 12-hour and 72-hour expectant management of premature rupture of membranes ( PROM ) in singleton term pregnancies . Methods In a prospect i ve , nonr and omized study , 566 low-risk women with singleton term pregnancies presenting with PROM were assigned to either 12-hour or 72-hour expectant management .  Patients who had not entered labor at the end of the assigned period were induced with oxytocin . The pregnancy outcome of both methods was compared with regard to infectious complications and method of delivery . Results There was no statistical difference in the rate of chorioamnionitis between the 12-hour and 72-hour expectant management groups ( 11.7 versus 12.7 % ; relative risk [ RR ] 0.9 , 95 % confidence interval [ CI ] 0.6 - 1.5 ; P = .83 ) . Cesareans were performed to a similar degree in both groups ( 4.7 versus 6.7 % ; RR 0.7 , 95 % CI 0.3 - 1.4 ; P = .39 ) . Fifty-five percent of the 12-hour group underwent  oxytocin induction  , compared with 17.5 % of those in the 72-hour group ( RR 5.8 , 95 % CI 3.9 - 8.5 ; P < .001 ) . Women undergoing induction after 72-hour expectant management had an increased risk of cesarean delivery compared with those after a 12-hour wait ( RR 5.9 , 95 % CI 2.3 - 15.1 ; P < .001 ) . Overall , women in the 12-hour group had shorter admission-to-discharge times than the 72-hour group ( 5 versus 6 days , 95 % CI of the difference 0.6 - 1.3 ; P < .01 ) . Conclusion Regimens of 12-hour and 72-hour expectant management of PROM are comparable regarding infectious complications and pregnancy outcome . However , the longer wait prolongs the interval to delivery and increases hospitalization costs OBJECTIVE We hypothesize that expectant management in the presence of premature rupture of membranes at term would result in a lower cesarean birth rate with no increase in maternal , fetal , or neonatal infection . STUDY DESIGN Term patients who consented to the study were r and omly allocated either to expectant management for 48 hours or to induction of labor 8 hours after premature rupture of membranes . Premature rupture of membranes was confirmed by sterile speculum examination of the vagina . Patients r and omized to expectant management  were transferred to antenatal care and were not examined vaginally until they went into labor . Patients r and omized to induction of labor had induction with oxytocin 8 hours after premature rupture of membranes . RESULTS Two hundred sixty-two patients were r and omized to the  expectant management  and induction of labor groups . The cesarean birth rate and the clinical diagnosis of postpartum endometritis was not significantly different in the two groups . Pathologic diagnosis of chorioamnionitis and funisitis , however , was significantly greater in the expectant management group ( p < 0.05 ) . Eight of the 15 babies with funisitis were admitted to the neonatal intensive care unit for therapy ( two in the induction of labor group and six in the expectant management group , p < 0.05 ) . CONCLUSION Expectant management did not reduce the incidence of cesarean birth and increased the pathologic diagnosis of funisitis and newborn requirements for neonatal intensive care A prospect i ve , r and omized study was conducted comparing the use of betamethasone and early delivery , early delivery alone , and expectant management in patients in the 28th to 34th week of pregnancy with premature rupture of the membranes ( PROM ) .  Tocolytic drugs were used to delay delivery until 24 hours had elapsed after the first dose of steroid or 24 to 48 hours of latent period had elapsed in the second group . There were ho significant differences in maternal age , gestation at PROM , maximum maternal temperature , birth weights , maternal hospital days , respiratory distress , maternal sepsis , or delivery routes in the three groups . Comparisons with one other similar prospect i ve , r and omized study support the concept that expectant management offers less risk from tocolytic side effects OBJECTIVE Our purpose was to compare induction of labor with preterm rupture of membranes between 34 and 37 weeks ' gestation with expectant management . STUDY DESIGN In this prospect i ve investigation 120 gravid women at > or = 34 weeks 0 days and < 36 weeks 6 days of gestation were r and omized to receive oxytocin induction  ( n = 57 ) or observation ( n = 63 ) . RESULTS Estimated gestational age at rupture of membranes ( 34.3 + /- 1.4 weeks vs 34.5 + /- 1.4 weeks ) and ultrasonographically estimated fetal weight ( 2230 + /- 321 gm vs 2297 + /- 365 gm ) were equivalent between groups ( not significant ) . Chorioamnionitis occurred more often ( 16 % vs 2 % , p = 0.007 ) , and maternal hospital stay ( 5.2 + /- 6.8 days vs 2.6 + /- 1.6 days , p = 0.006 ) was significantly longer in the control group . Neonatal sepsis was also more common in the observation group ( n = 3 ) than among induction patients ( n = 0 ) , but the difference was not statistically significant . CONCLUSION Aggressive management of preterm premature rupture of the membranes at > or = 34 weeks 0 days of gestation by induction of labor is safe for the infant in our population and avoids maternal-neonatal infectious complications OBJECTIVE This study was undertaken to determine the effect of antenatal betamethasone administration on the incidences of respiratory distress syndrome , intraventricular hemorrhage , and perinatal infectious morbidity in the setting of preterm premature rupture of membranes . STUDY DESIGN We performed a nonconcurrent prospect i ve analysis of women with singleton pregnancies who were delivered between 24 and 32 weeks ' gestation after preterm premature rupture of membranes . Patients were subdivided into 2 groups according to betamethasone exposure : ( 1 ) none ( control group ) and ( 2 ) two 12-mg doses in a 24-hour interval on admission ( single-course group ) . Patients who received > 2 doses of betamethasone were excluded . All patients received broad-spectrum prophylactic antibiotics . Data were analyzed with the Student t test , the chi(2 ) test , and the Fisher exact test . Multiple logistic regression analyses incorporated multiple variables considered risk factors for respiratory distress syndrome and intraventricular hemorrhage . P < .05 for all 2-tailed tests was considered significant . RESULTS A total of 362 patients were included , with 203 in the control group and 159 in the single-course group . Patients in these groups were delivered at 31.0 + /- 3.0 and 30.2 + /- 2.7 ( mean + /- SD ) weeks ' gestation , respectively . The groups were similar with respect to selected demographic characteristics , latency until delivery , mode of delivery , birth weight , and maternal group B streptococcal colonization status . Univariate analysis demonstrated significant decreases in the frequencies of both respiratory distress syndrome ( odds ratio , 0.31 ; 95 % confidence interval , 0.2 - 0.5 ) and grade III/IV intraventricular hemorrhage ( 
    Output:
    
Maternal infection as well as respiratory distress syndrome ( RDS ) & neonatal sepsis ( NS ) were not different between the two groups .
Based on the available evidence , ID in pregnancies complicated with PPROM between 28 and 34 weeks carries some maternal and neonatal risks with no added benefits .