***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 Gr and multiparous women in poor and under-privileged setting s run a high risk of uterine rupture at labor induction . The purpose was to eluci date whether vaginal misoprostol medication is a safe and cost-effective alternative induction method in gr and multiparous women , in whom , under prevailing circumstances , induction by oxytocin is associated with high risk of adverse maternal outcome of pregnancy . METHOD One hundred and sixty-five gr and multiparous parturient women with five or more previous deliveries were divided into two groups . The first group ( n=134 ) had the fetus alive and the second ( n=31 ) had late intrauterine fetal death . Both groups were subject to induction of labor by use of vaginal misoprostol in a dose of 50 microg ( live fetus ) and 100 microg ( intrauterine fetal death ) . No additional oxytocin was utilised . RESULTS Labor induction by vaginal misoprostol was successful in gr and multiparous women . The proportion of women requiring a Cesarean section was 6.0 % , which is less than one third of the average Cesarean section rate in the setting studied . Women with fetus alive had significantly shorter application-to-expulsion interval ( AEI ) than women with fetal death ( 10.1 versus 15.4 hours ; p=0.039 ) . Significantly shorter AEI was recorded in women with prelabor rupture of membranes ( 9.1 hours ) than in women with intact membranes ( 12.9 hours ) ( p=0.01 ) . With Bishop 's score > or = 5 and < 5 AEI was 8.7 hours and 14.4 hours , respectively ( p=0.001 ) . No significantly adverse neonatal or maternal outcomes of pregnancy were registered and it was specifically noted that no uterine rupture occurred among the 165 gr and multiparous women induced . CONCLUSIONS Induction of under-privileged gr and multiparous women with live fetus or with fetal death can be performed safely and cost-effectively by vaginal misoprostol OBJECTIVE The objective was to test the safety and efficacy of a pulsatile oxytocin infusion protocol in which a computer-controlled pump adjusts the oxytocin dose rate on the basis of uterine activity . STUDY DESIGN A total of 358 women were enrolled in , and 310 completed , a prospect i ve , r and omized clinical trial comparing three protocol s for the induction of labor with oxytocin : aggressively managed continuous infusion , conservatively managed continuous infusion , and computer-controlled pulsatile infusion . Results were analyzed with Student t and chi 2 " goodness-of-fit " tests . RESULTS Mean doses of oxytocin  in the group receiving pulsed oxytocin were approximately 20 % of the dose rates in the continuous infusion protocol s. All protocol s effectively established labor in the majority of patients , although nulliparous women with unfavorable Bishop scores were more likely to fail to establish labor within a 24-hour period when treated with the aggressive continuous protocol . There were no differences in the rates of cesarean section , hyperstimulation , blood gases , or Apgar scores among the three treatment groups . CONCLUSIONS  Oxytocin  dosage was minimized by use of a computer-controlled pump . With the exception of aggressively managed nulliparous women , there were no differences in the percentages of patients with successful inductions among the three protocol s. The percentage of successful inductions was lower for aggressively managed nulliparous women than for other patient and protocol groups OBJECTIVE The trail was conducted to obtain an unbiased comparison of the relative merits of endocervical and vaginal prostagl and in E2 gel in a weighted case mix of parous and nulliparous women with favorable and unfavorable cervical features . STUDY DESIGN Multicenter r and omized trial with 285 participants , ( three exclusions ) was performed with sealed envelopes stratified for parity and Bishop score . RESULTS Outcomes of labor and delivery were clearly related to the cervical score at trial entry , especially in nulliparous women .  Endocervical prostagl and in E2 had a more marked effect on cervical ripeness than did vaginal prostagl and in E2 , but this did not result in any differences in more substantive outcomes . Frequencies of delivery within 12 ( 50 % ) and 24 hours ( 77.7 % ) , cesarean section ( 7.3 % ) , instrumental vaginal delivery ( 11.7 % ) , and poor infant outcomes were similar with both preparations . CONCLUSION Because differences in effectiveness between endocervical and vaginal prostagl and in E2 in triacetin gel are marginal , preferences of women and clinicians can determine the choice between them The objective of the study was to evaluate pre-induction risk factors for ( i ) assisted vaginal delivery ( forceps or vacuum extraction ) , ( ii ) caesarean section , ( iii ) failed induction followed by caesarean section  , and from these to evaluate a score of the ' Disadvantages Following Induction of Labour ' ( the DisFIL score ) . The study was a case-control study applied on a prospect i ve cohort of 336 pregnant women induced by local PGE2 . Assisted vaginal delivery was associated with primiparity ( OR ( odds ratio ) = 10.7 ; CI , 3.6 - 32.0 ) and higher pelvic scores ( Bishop score : OR = 1.9 ; CI , 1.4 - 2.6 ) . Caesarean section was related to higher maternal age ( P < 0.001 ) and lower pelvic scores ( Bishop score : OR = 0.7 ; CI , 0.5 - 1.0 , P < 0.05 ) . When performed because of fetal distress , assisted vaginal delivery and caesarean section were both associated with lower fetal weights ( P < 0.05 ) . Failed induction followed by caesarean section was related to primiparity ( P < 0.0001 , Fisher 's test ) and lower pelvic scores ( Bishop score : OR = 0.6 ; CI , 0.4 - 0.9 ) . A higher ' DisFIL score ' was associated with primiparity ( OR = 4.7 ; CI , 2.8 - 8.0 ) , higher maternal age ( P < 0.01 ) , lower pelvic scores ( P < 0.01 , chi 2 test ) and PGE2 in intracervical gel rather than in vaginal pessaries ( OR = 2.1 ; CI , 1.4 - 3.2 ) . It is concluded that the major predictors of ' Disadvantages Following Induction of Labor ' by local PGE2 are primiparity , high maternal age , low pelvic scores and the method of One thous and twenty inductions of labor by amniotomy and continuous infusion of oxytocin at the Royal Women 's Hospital were review ed . Three different starting rates of infusion of oxytocin were used by altering the concentration to 2 , 5 , or 10 U/L. There was no difference in success of induction as measured by induction-to-delivery interval or by rate of vaginal , delivery using higher initial concentrations of oxytocin . Higher pre-induction Bishop scores were associated with shorter labors and more vaginal deliveries . This study was retrospective and nonr and omized , but within these limits it suggests that “ low-dose ” oxytocin infusion is effective for induction of labor and may be associated with fewer hazards than are higher doses OBJECTIVE To compare dinoprostone gel and insert in achieving successful vaginal delivery in nulliparous and multiparous women . STUDY DESIGN 220 nulliparous and 100 multiparous with a Bishop score < or = 7 were r and omized to receive dinoprostone either gel or insert for cervical ripening . The main outcome measures were the rate and latency of vaginal delivery . RESULTS In nulliparous women no significant differences were found between the gel and insert groups in the rate of vaginal delivery ( 85.6 % vs. 80.7 % ) delivery < or = 12 ( 36.8 % vs. 32.9 % ) and < or = 24h ( 85.3 % vs. 93.4 % ) regardless of the preinduction Bishop score . Nulliparous with Bishop score < or = 4 treated with the insert had a decreased risk ( p<0.05 ) of post partum hemorrhage ( 4.8 % ) when compared with nulliparous treated with gel ( 16.7 % ) . On the contrary , in multiparous the time to delivery interval was significantly shorter in the gel treated group ( 9.9+/-4.9h vs. 13.1+/-5h ; p<0.001 ) with more patients delivering vaginally < or = 12h ( 75 % vs. 37.5 % , p<0.001 ) , regardless of the preinduction Bishop score . CONCLUSION Both dinoprostone gel and insert are efficient in achieving cervical ripening and successful labor in nulliparous and multiparous . In multiparous , however , the gel significantly reduces the time to vaginal delivery with more patients delivering vaginally < or = 12h , regardless of the Bishop score One hundred consecutive women with singleton pregnancies and primary rupture of membranes ( PROM ) after 36 weeks of gestation were included in a prospect i ve , r and omized trial of intravenous infusion of oxytocin ( up to 30 mIU/min ) versus low‐dose prostagl and in F2α(PGF2αup to 6.0 μg/min ) .  Cesarean section was performed in 12 patients because of suspected disproportion or intra‐uterine asphyxia .  Effective contractions or labor progress failed to become established within 8 hours in another 4 women stimulated with PGF2α and 2 stimulated by oxytocin .  The stimulation delivery time ( hours ) for the remaining 82 women treated with PGF2α or oxytocin , respectively was 8.7 against 12.1 for initial Bishop score < 5 ( p<0.01 ) , ( Mann‐Whitney test ) , 7.2 vs. 7.1 for Bishop score 5–8 and 5.7 vs. 4.2 for Bishop score > 8 . Patients with initial Bishop score < 5 seemed to need analgetics less often when treated with PGF2α than with oxytocin . Frequencies of side effects and instrumental deliveries as well as the fetal outcome were similar for the two treatment schedules . The results of the study suggest that low‐dose PGF2α infusion may be the more appropriate treatment for women with an unfavorable initial Bishop score OBJECTIVE To study the incidence and indications for labour induction  and study the predictors of failed induction . MATERIAL AND METHOD A hospital based prospect i ve study done over a 12 month period between 1st November 2007 to 30th October 2008 . SELECTION CRITERIA Singleton pregnancies beyond 37 weeks with vertex presentation and unscarred uterus requiring induction of labour . RESULTS The incidence of  labour induction  was 19.7 % . Operative delivery was 34.6 % in the study group and 27.4 % in those with spontaneous onset of labour . 74.07 % of the induction group required operative delivery for failed induction and 25.03 % for foetal distress . The predominant indication for induction was post term pregnancy ( 51.28 % ) followed by PROM ( 17.3 % ) , isolated oligohydramnios ( 8.97 % ) , hypertensive disorders of pregnancy ( 8.33 % ) , maternal perception of decreased foetal movements ( 7.69 % ) and others . Failed induction was higher in nulliparas ( 41.2 % ) as compared to multiparas ( 23.7 % ) . Failure rate was 53.8 % when maternal age > 30 y and 28.2 % in those < 30 y. Women with normal BMI had a failure rate of 25.6 % compared to 36 % for overweight and 44.4 % for obese women . 24.1 % had failed induction when Bishop score was > 5 and 40.8 % when Bishop score was < 5 . Between 38 - 41 weeks pregnancy failed induction occurred in 28 - 31 % while it was higher at < 38 weeks and > 41 weeks pregnancy . The best outcome was seen when the birth weight was 2500 - 2900 g ( 22.5 % failures ) while 72.7 % had failed induction when the birth weight was > 3500 g. The duration of induction was > 24 hours in 42.6 % of women and 48.2 % were in the latent phase of labour when taken for caesarean section . CONCLUSION Despite the proven benefit of induction of labour in selected cases , one must keep in mind its impact on increasing the rates of operative delivery . Strategies for developing practice guidelines may help to prevent unwarranted case selection and help to reduce the current high operative delivery rates This paper is a prospect i ve study of the outcome of labour in 109 patients with favourable and unfavourable cervices in whom labour was induced by intravaginal prostagl and in , with supplementary syntocinon infusion where necessary . There were 61 primigravidae and 48 multigravidae . The rate of operative intervention was virtually no higher than in those labours of spontaneous onset . The length of labour varied inversely with the Bishop score of the cervix before induction , with a coefficient of correlation of -0·995 for primigravidae and of -0·929 for multigravidae . Bishop score was shown to be a poor indicator of the number of doses of prostagl  and in needed for successful induction OBJECTIVES To compare transvaginal sonography for cervical length measurement 
    Output:
    
The sROC curve of the Bishop score in the prediction of cesarean delivery indicated a poor predictive capacity .
The Bishop score is a poor predictor for the outcome of induced labor at term and should not be used to decide whether to induce labor or not