***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
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    Input: OBJECTIVE : To compare induction of labor at gestational age 41 weeks with expectant management in regard to neonatal morbidity . Secondary aims were to assess the effect of these managements on mode of delivery and maternal complications . METHODS : Between September 2002 and July 2004 , postterm women with singleton cephalic presentation and no prelabor rupture of membranes were r and omly assigned to induction of labor at 289 days or antenatal fetal surveillance every third day until spontaneous labor . Main outcome measures were neonatal morbidity , operative delivery rates , and maternal complications . RESULTS : Five hundred eight women were r and omly assigned , 254 in each group . No differences of clinical importance were observed in women in whom labor was induced compared with women who were expectantly managed with regard to the following outcomes : neonates whose 5-minute Apgar score was less than 7 ( three neonates in the induction group compared with four in the monitoring group , P=.72 ) ; neonates whose umbilical cord pH was less than 7 ( three compared with two , P=.69 ) ; prevalence of cesarean delivery ( 28 compared with 33 , P=.50 ) ; or prevalence of operative vaginal delivery ( 32 compared with 27 , P=.49 ) . In the induction group more women had precipitate labors ( 33 compared with 12 , P<.01 ; number needed to treat was 13 ) , and the duration of second stage of labor was more often less than 15 minutes ( 94 compared with 56 , P<.01 ; number needed to treat was 7 ) . CONCLUSION : No differences were found between the induced and monitored groups regarding neonatal morbidity or mode of delivery , and the outcomes were generally good . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00385229 LEVEL OF EVIDENCE : Background There is a well recognized risk of complications for both women and infants of a twin pregnancy , increasing beyond 37 weeks gestation . Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy , however , up to 50 % of twins will be born after this time . The aims of this r and omised trial are to assess whether elective birth at 37 weeks gestation compared with st and ard care in women with a twin pregnancy affects the risk of perinatal death , and serious infant complications . Methods / Design Design : Multicentred r and omised trial . Inclusion Criteria : women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy . Trial Entry & R and omisation : Following written informed consent , eligible women will be r and omised from 36 + 6 weeks gestation . The r and omisation schedule uses balanced variable blocks , with stratification for centre of birth and planned mode of birth . Women will be r and omised to either elective birth or st and ard care . Treatment Schedules : Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation . Where the plan is for vaginal birth , this will involve induction of labour . Where the plan is for caesarean birth , this will involve elective caesarean section . For women allocated to st and ard care , birth will be planned for 38 weeks gestation or later . Where the plan is for vaginal birth , this will involve either awaiting the spontaneous onset of labour , or induction of labour if required . Where the plan is for caesarean birth , this will involve elective caesarean section ( after 38 and as close to 39 weeks as possible ) . Primary Study Outcome : A composite of perinatal mortality or serious neonatal morbidity . Sample Size : 460 women with a twin pregnancy to show a reduction in the composite outcome from 16.3 % to 6.7 % with adjustment for the clustering of twin infants within mothers ( p = 0.05 , 80 % power ) . Discussion This is a protocol for a r and omised trial , the findings of which will contribute information about the optimal time of birth for women with an uncomplicated multiple pregnancy at and beyond 37 weeks gestation . Clinical Trial Registration Current Controlled Trials IS RCT OBJECTIVE To clarify the safety of elective induction of labor at 39 weeks of gestation . STUDY DESIGN Prospect i ve r and omized study . SUBJECTS AND METHODS Uncomplicated nulliparas ( N = 194 ) were r and omly assigned at 36 weeks of gestation . Labor was electively induced in 63 women at 39 weeks of gestation in the active management group ( I group , N = 98 ) . Spontaneous labor onset was expected with semi-weekly nonstress test ( NST ) and amniotic fluid index ( AFI ) by 42 weeks of gestation in the expectant group ( E group , N = 96 ) . Perinatal events were compared between the 2 groups . RESULTS A significantly higher incidence of meconium-stained amnios ( 19.4 % vs 3.2 % ) and fetal resuscitation ( 16.7 % vs 4.8 % ) was found in the E group than in the I group . Also , although a significantly higher incidence of epidural analgesia was noted in the I group ( 89 % ) than in the E group ( 54 % ) ( labor onset > or = 39 weeks , N = 72 ) , the duration of the 1st stage was shorter in I group and the duration of the 2nd stage was not significantly different . No other significant difference was noted between the 2 groups in terms of the rate of C-section , blood loss , incidence of pathological FHR , birth weight , Apgar score , umbilical arterial pH , or admission to NICU . CONCLUSION Active management of labor at 39 weeks could be made as safely as expectant management with modified biophysical profile monitoring OBJECTIVE Management of the uncomplicated pregnancy prolonged beyond the estimated date of confinement is controversial , particularly when the cervix is unfavorable for induction . The benefit of reducing potential fetal risk with induction of labor must be balanced against the morbidity associated with this procedure . The objective of this study was to compare two strategies for managing postterm pregnancy ( i.e. , immediate induction and expectant management ) . STUDY DESIGN Four hundred forty patients with uncomplicated pregnancies at 41 weeks ' gestation were r and omized to either immediate induction of labor ( n = 265 ) or expectant management ( n = 175 ) . Patients with expectant management underwent nonstress testing and amniotic fluid volume assessment twice per week . Patients in the induction group underwent induction within 24 hours of r and omization . To evaluate the efficacy of intracervical prostagl and in E2 gel , patients in the induction group were r and omized in a 2:1 scheme to receive either 0.5 mg prostagl and in E2 gel or placebo gel intracervically 12 hours before induction of labor with oxytocin . RESULTS The incidence of adverse perinatal outcome ( neonatal seizures , intracranial hemorrhage , the need for mechanical ventilation , or nerve injury ) was 1.5 % in the induction group and 1 % in the expectant management group ( p > 0.05 ) . There were no fetal deaths in either group . There were no differences in mean birth weight or the frequency of macrosomia ( birth weight > or = 4000 gm ) between the two groups ( p > 0.05 ) . Regardless of parity , prostagl and in E2 intracervical gel was not more effective than placebo in ripening the cervix . The cesarean delivery rate was not significantly different in the expectant ( 18 % ) , prostagl and in E2 gel ( 23 % ) , or placebo gel ( 18 % ) groups . CONCLUSIONS Adverse perinatal outcome in otherwise uncomplicated pregnancies of > or = 41 weeks is very low with either of the management schemes described . Thus from the perspective of perinatal morbidity or mortality either management scheme is acceptable Please cite this paper as : Dodd J , Crowther C , Haslam R , Robinson J. Elective birth at 37 weeks of gestation versus st and ard care for women with an uncomplicated twin pregnancy at term : the Twins Timing of Birth R and omised Trial . BJOG 2012;119:964–974 BACKGROUND Robust evidence to direct management of pregnant women with mild hypertensive disease at term is scarce . We investigated whether induction of labour in women with a singleton pregnancy complicated by gestational hypertension or mild pre-eclampsia reduces severe maternal morbidity . METHODS We undertook a multicentre , parallel , open-label r and omised controlled trial in six academic and 32 non-academic hospitals in the Netherl and s between October , 2005 , and March , 2008 . We enrolled patients with a singleton pregnancy at 36 - 41 weeks ' gestation , and who had gestational hypertension or mild pre-eclampsia . Participants were r and omly allocated in a 1:1 ratio by block r and omisation with a web-based application system to receive either induction of labour or expectant monitoring . Masking of intervention allocation was not possible . The primary outcome was a composite measure of poor maternal outcome --maternal mortality , maternal morbidity ( eclampsia , HELLP syndrome , pulmonary oedema , thromboembolic disease , and placental abruption ) , progression to severe hypertension or proteinuria , and major post-partum haemorrhage ( > 1000 mL blood loss ) . Analysis was by intention to treat and treatment effect is presented as relative risk . This study is registered , number IS RCT N08132825 . FINDINGS 756 patients were allocated to receive induction of labour ( n=377 patients ) or expectant monitoring  ( n=379 ) . 397 patients refused r and omisation but authorised use of their medical records . Of women who were r and omised , 117 ( 31 % ) allocated to induction of labour developed poor maternal outcome compared with 166 ( 44 % ) allocated to expectant monitoring ( relative risk 0.71 , 95 % CI 0.59 - 0.86 , p<0.0001 ) . No cases of maternal or neonatal death or eclampsia were recorded . INTERPRETATION Induction of labour is associated with improved maternal outcome and should be advised for women with mild hypertensive disease beyond 37 weeks ' gestation . FUNDING ZonMw OBJECTIVE Studies of  cesarean delivery ( CD ) rates  among women undergoing induction of labor ( IOL ) often compare such women to women experiencing spontaneous labor at similar gestational ages . We sought to examine the association between IOL at various gestational ages and CD , accounting for the effect of increased gestational age among the comparison group who were managed expectantly . STUDY DESIGN We conducted a retrospective cohort study of all term , singleton , cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor . For each gestational age of induction , we created a comparison group of women who were undelivered at that gestational age , and who experienced labor at some future gestational age . RESULTS In women undergoing IOL at 38 weeks gestation , the CD rate was 11.9 % as compared to 13.3 % ( P = .42 ) of women beyond 38 weeks gestation . The CD rate for induction of labor compared to ongoing pregnancy was 14.3 % versus 15.0 % ( P = .62 ) at 39 weeks , 20.4 % versus 19.0 % ( P = .41 ) at 40 weeks , and 24.3 % versus 26.0 % ( P = .39 ) at 41 weeks . When controlling for potential confounding , there was a higher rate of CD among women with expectant management beyond 38 weeks ( adjusted odds ratio [ AOR ] 1.80 ; 95 % CI 1.29 - 2.53 ) , 39 weeks ( 1.39 ; 95 % CI 1.08 - 1.80 ) , and 40 weeks ( AOR 1.27 ; 95 % CI 1.00 - 1.62 ) . CONCLUSION Our findings suggest that IOL may not increase a woman 's  risk of CD when compared to expectant management . While this question has been addressed prospect ively at 41 weeks gestation , it requires further examination at earlier gestations and among various subgroups 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 A prospect i ve r and omized controlled trial design ed to investigate selective planned delivery is reported : 264 obstetrically normal women in the 38th week of pregnancy were admitted to this trial and 184 completed it . The infants of mothers in the planned delivery group had higher serum bilirubin levels on the fifth day post partum than control infants but no baby required treatment for hyperbilirubinaemia . Mothers in the planned delivery group required significantly greater amounts of pethidine  while control mothers had a significantly higher incidence of me 
    Output:
    
AUTHOR 'S CONCLUSIONS Induction of labour in women with intact membranes reduces the risk of caesarean section .