***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: Aim : To evaluate the efficacy of sweeping of fetal membranes for induction of labor in uncomplicated term pregnancies . Methods : A r and omized controlled trial was performed in 122 pregnant women beyond 39 weeks of gestation with no complications . The women were assigned to have their membranes swept or not ( controls ) for labor induction . The main outcome measures included duration of pregnancy and possible complications of sweeping of membranes , including rupture of membranes , postpartum infections , and vaginal bleeding . Results : Twenty-one patients did not give birth in our hospital and were , therefore , excluded from the study ; 101 women completed the study ( 51 patients in the control group and 50 women in the study group ) . There were no statistically significant differences in maternal age , parity , birth weight , and Bishop score in the two groups . The mean interval between sweeping ( stripping ) and vaginal examination until delivery was 7.7 ± ( SD ) 6.9 and 7.1 ± 5.6 days in the sweeping and in the control group , respectively ( p = 0.61 ) . Of the 101 pregnant women , only 6 patients had premature rupture of membranes ( 2 in the sweeping group and 4 in the control group ) . There were no statistically significant differences between these individuals ( p = 0.68 ) . Significant vaginal bleeding was not observed in the two groups . Meconium-stained amniotic fluid was seen in 13 women : 8 in the sweeping group and 5 in the control group . There were no statistically significant differences among the women who had meconium-stained fluid in case and control groups ( p = 0.39).There were no differences between women who had puerperal fever ( 3 in the sweeping group and 2 in the control group ; p = 0.68).12 of the 101 women ( 6 in each group ) had cesarean section performed , but there was no difference betweeen the two groups . Conclusion : Sweeping of membranes at 39 weeks of gestation has no significant clinical effect on the duration of pregnancy Objective . To compare effectiveness and safety of 25 μg vaginal misoprostol versus Foley catheter and oxytocin for cervical ripening and labor induction in pregnant women with unripe cervices . Design . R and omized controlled trial . Setting . A public maternity in Recife , Brazil . Sample . A total of 240 pregnant women . Methods . Women with a term or post‐term , live , singleton fetus in cephalic presentation , intact membranes , Bishop score < 6 , not in labor , medically indicated for labor induction . They were r and omly divided in Group 1 , where 119 women received 25 μg of intravaginal misoprostol every 6 hours for a maximum of four doses ; and Group 2 , where 121 women had a 14‐F Foley catheter inserted into their cervical canal . Once past the internal os , the balloon was inflated .  Intravenous oxytocin was initiated after the balloon was spontaneously extruded from the cervix or after 24 hours . Results . There were no significant differences between the groups regarding baseline  characteristics . Misoprostol was more effective in inducing labor than Foley catheter and oxytocin . Mean induction‐to‐vaginal delivery time  with misoprostol was shorter ( 17.3 vs. 20.2 hours , p = 0.016 ) . There were more vaginal deliveries in the misoprostol group at 12 ( p < 0.001 ) and 18 ( p = 0.007 ) hours , but the difference was no longer statistically significant at 24 and 48 hours . There were no significant differences in uterine contraction abnormalities , puerperal infection or neonatal outcomes . Conclusions . Vaginal misoprostol  is more effective than and as safe as  Foley catheter and oxytocin for induction of labor in term and post‐term pregnancy OBJECTIVE : To estimate if membrane sweeping increases the rate of  prelabor rupture of membranes . METHODS : This r and omized trial of term , uncomplicated pregnancies included 300 patients . Patients were r and omly assigned into sweep or no-sweep groups , with patients and delivering providers blinded to group allocation . Only the examining provider in the clinic was unblinded to group allocation . Membranes were then swept or not swept at each weekly visit from 38 weeks of gestation onward , depending on the r and omization . Data collected included parity , cervix examination at each visit , estimated gestational age at delivery , rupture of membranes , and maternal or fetal complications . RESULTS : A total of 162 patients were r and omly assigned to the  membrane sweep group  and 138 to the no-sweep  group . There was no difference in baseline characteristics or obstetric and neonatal outcomes between the groups . The average gestational age at delivery and induction rate were not different . The overall prelabor rupture of membranes rate was not significantly higher in the membrane sweep group ( 12 % compared with 7 % ) ( P=.19 ) ; however , patients with a cervix more than 1 cm dilated at time of membrane sweeping were more likely to have prelabor rupture of membranes if they were in the membrane sweep group ( 9.1 % compared with 0 % ; relative risk 1.10 , 95 % confidence interval 1.03–1.18 ) . CONCLUSION : No benefit in gestational age at delivery or reduction of postmaturity occurred from membrane sweeping . Although the overall prelabor rupture of membranes rates were similar , patients with membrane sweeping occurring at more than 1 cm cervical dilation may be at increased risk of prelabor rupture of membranes . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00294242 LEVEL OF EVIDENCE : Objective . To evaluate the efficacy of acupuncture for labor stimulation . Methods . Nulliparous women at 38 weeks or greater were r and omized to traditional Chinese medicine ( TCM ) acupuncture , sham acupuncture , or usual care only groups . Acupuncture points LI4 , SP6 , BL32 , and BL54 were needled bilaterally . The primary outcome was time from enrollment to delivery . Secondary outcomes included rates of spontaneous labor and cesarean delivery . Medical records were abstract ed for maternal demographic , medical , and delivery outcome data . ANOVA , Student 's t-test , Chi-square , and Kaplan – Meier statistics were used to compare groups . Results . Eighty-nine women were enrolled and r and omized . Maternal age , gestational age , prior acupuncture experience , tobacco , alcohol and drug use , gravida , and history of gynecological surgery were similar among the groups . There were no statistically significant differences among groups for time from enrollment to delivery ( p = 0.20 ) , rates of spontaneous labor ( p = 0.66 ) , or rates of cesarean delivery ( p = 0.37 ) . Rates of maternal and neonatal outcomes were not significantly different . Conclusion . TCM acupuncture was not effective in initiating spontaneous labor or reducing the rate of cesarean delivery compared with sham acupuncture or usual medical care Please cite this paper as : Modlock J , Nielsen B , Uldbjerg N. Acupuncture for the induction of labour :  a double‐blind r and omised controlled study . BJOG 2010;117:1255–1261 OBJECTIVE : To estimate the effect of serial membrane sweeping on the onset of labor in women who planned vaginal birth after cesarean ( VBAC ) . METHODS : Women at term with one transverse lower segment cesarean delivery who were suitable for and who planned VBAC were approached to participate . Participants were r and omly assigned to weekly membrane sweeping or weekly vaginal assessment for Bishop score until delivery . Participants and delivery providers were blinded to the allocated treatment . St and ard obstetric care was given to all participants . The primary outcome was onset of labor which was defined as the presence of spontaneous regular and painful contractions that cause cervical dilation to at least 3 cm or prelabor rupture of membranes . Secondary outcomes included induction of labor and repeat cesarean delivery . RESULTS : One hundred eight women were r and omly assigned to membrane sweeping and 105 to control . The spontaneous labor rate was 78.5 % compared with 72.1 % ( relative risk [ RR ] 1.1 , 95 % confidence interval [ CI ] 0.9–1.3 ; P=.34 ) , the induction of labor rate was 12.1 % compared with 9.6 % ( RR 1.3 , 95 % CI 0.6–2.8 ; P=.66 ) , and the all-cause cesarean delivery rate was 40.2 % compared with 44.2 % ( RR 0.9 , 95 % CI 0.7–1.2 ; P=.58 ) for the membrane sweeping and control groups , respectively . Gestational age at delivery ( mean±st and ard deviation ) of 39.6±1.0 weeks for the membrane sweeping group compared with 39.6±0.9 weeks for the control group ( P=.84 ) was no different . CONCLUSION : Serial membrane sweeping at term in women who planned VBAC has no significant effect on the onset of labor , pregnancy duration , induction of labor , or repeat cesarean delivery . CLINICAL TRIAL REGISTRATION : IS RCT N , is rct n.org , IS RCT N55163179 . LEVEL OF EVIDENCE : OBJECTIVE To compare the efficacy and safety of oral misoprostol with intracervical prostagl and in E2 ( PGE2 ) gel for the active management of premature rupture of membranes ( PROM ) at term . METHODS Women with pregnancies between 37 and 42 weeks presenting with PROM at term and a Bishop score of 5 or less were r and omly assigned to receive either a 4-hourly oral dose of 50 microg of misoprostol up to a maximum of 3 doses or 2 applications of intracervical PGE2 gel at a 6-hour interval . Oxytocin was given if labor had not started after 12 hours . RESULTS Twenty women in the misoprostol group ( n=31 ) delivered within 12 hours compared with 5 in the PGE2 group ( n=30 ) ( P<0.001 ) . The induction-to-delivery interval in the misoprostol group was shorter than in the PGE2 gel group ( 615 min vs 1070 min ; P<0.001 ) . The mode of delivery was comparable between the 2 groups ( P=0.821 ) . Abnormalities in uterine contractions and neonatal outcomes were also comparable . The requirement for oxytocin was lower and patient satisfaction was better in the misoprostol group . CONCLUSION Oral misoprostol is a safe and efficacious alternative to intracervical PGE2 gel in the active management of PROM at term OBJECTIVE : To estimate the clinical effectiveness of acupuncture to induce labor . METHODS : This study was a r and omized controlled trial of acupuncture compared with sham acupuncture .  Women who were scheduled for a postterm induction with a singleton pregnancy and cephalic presentation were eligible for the study . Women received two acupuncture or sham acupuncture sessions over a 2-day period before the planned medical/pharmacological induction . The principal primary outcomes related to the need for induction methods and time from the administration of the intervention to delivery . RESULTS : Three hundred sixty-four women were r and omly assigned to the trial ( treatment n=181 and control n=183 ) . Women did not differ in their need for induction methods between groups : prostagl and in induction : relative risk ( RR ) 1.20 , 95 % confidence interval ( CI ) 0.96–1.51 , P=.11 ; artificial rupture of membranes only : RR 0.93 , 95 % CI 0.72–1.20 , P=.57 ; oxytocin only : RR 0.89 , 95 % CI 0.60–1.32 , P=.55 ; artificial rupture of membranes plus oxytocin : RR 0.87 , 95 % CI 0.57–1.33 , P=.52 ; prostagl and ins , artificial rupture of membranes , and oxytocin :  RR 0.84 , 95 % CI 0.37–1.91 , P=.68 . The median time from acupuncture to delivery was 68.6 hours ( interquartile range 53.9–79.5 ) compared with 65 hours ( interquartile range 49.3–76.3 ) for women in the control group . CONCLUSION : Two sessions of manual acupuncture , using local and distal acupuncture points , administered 2 days before a scheduled induction of labor did not reduce the need for induction methods or the duration of labor for women with a postterm pregnancy . CLINICAL TRIAL REGISTRATION : Australian New Zeal and Clinical Trials Registry , www.anzctr.org.au , ACTRN12606000494538 LEVEL OF EVIDENCE : OBJECTIVE To evaluate the effectiveness of membrane sweeping at 41 weeks for the prevention of  post-term pregnancy .  DESIGN A multicentre r and omised controlled trial . SETTING Fifty-one primary care midwifery practice s in the 
    Output:
    
Prostagl and in E2 ( PGE2 ) and vaginal misoprostol were more effective than oxytocin in bringing about vaginal delivery within 24 hours but were associated with more uterine hyperstimulation .
Mechanical methods reduced uterine hyperstimulation compared with PGE2 and misoprostol , but increased maternal and neonatal infectious morbidity compared with other methods .
Membrane sweeping reduced post-term gestations .
Conclusions Research is needed to determine benefits and harms of many induction methods