***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: 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 In 345 women with a favorable cervical score at due date , labor was either induced by means of intravaginal application of tablets containing 3 mg of prostagl and in E2 or spontaneous onset of labor was awaited until the 42nd week of pregnancy . Eighty percent of the nulliparae and 96.3 % of the multiparae of the induction group gave birth within 24 h of the administration of the first tablet . All pertinent delivery intervals were significantly shorter in this group compared to those women where spontaneous onset of labor was awaited . The rate of operative deliveries was lower in the induction group . With the exception of 1 fetal death 3 days after due date , fetal outcome was excellent in both groups . Elective induction was at least equivalent to awaiting the onset of spontaneous labor and was not associated with higher complication rates due to the method of induction 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 meconium staining of the amniotic fluid . However , the infants in the two groups had similar Apgar scores at birth . There was one stillbirth in the control group ; this was due to unrecognized fetal hypoxia during labour induced at 42 weeks for postmaturity In a prospect i ve r and omized study , pregnancies with unfavorable cervix and well established gestational age of at least 42 weeks were selected for management by either antepartum fetal testing or prostagl and in gel induction of labor . Of the 108 pregnancies studied , 57 ( 53 % ) had labor induced and 51 ( 47 % ) continued without intervention . Comparison of the two groups showed no difference in meconium staining , fetal distress , length of first stage of labor , the need for intervention , or the mode of delivery . In terms of Apgar score the neonatal outcome was not significantly different but a greater proportion of the babies ( 7.8 % versus 1.8 % ) in the noninduced group required intubation . Our data show that there is no particular advantage in letting the pregnancy go beyond 42 completed weeks of gestation especially if prostagl and in is available for induction of labor Objecfive To determine the proper management of pregnancy  in uncomplicated cases going beyond 42 weeks Objective To compare the impact on perinatal outcome of two different protocol s for antenatal fetal monitoring after 42 weeks gestation Abstract . In a prospect i ve r and omized study spontaneous and oxytocin induced labor “ for convenience ” have been compared with respect to uterine activity , duration of labor , the condition of the fetus and the newborn infant . The study consists of 84 normal patients , of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II ; 41 patients served as controls . No difference in maternal age , number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups . The following parameters were calculated : duration of labor , uterine activity , amount of bleeding in the third stage of labor , number of early and late decelerations as well as number of episodes of bradycardia in the CTG‐recordings , birth weight , Apgar score one and five minutes post‐delivery and blood gases in mother and child 60 seconds after delivery . No significant differences between the two groups were found . It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy , careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring In a prospect i ve , r and omised trial , 111 obstetrically normal pregnant women , who had elective induction of labour performed between 39 and 40 weeks , were compared with 117 controls who were managed expectantly until 41 weeks . Compared with the controls , the patients who had elective induction of labour had significantly less meconium staining in labour and a smaller blood-loss after delivery . The mean length of labour , the amount of pethidine used , and the Apgar scores at 1 minute were similar in the two groups . In the electively induced group , the caesarean-section rate was lower and the use of epidural analgesia more common than in the controls , but the differences were mot statistically signficant . The hour of delivery was similar in the two groups , suggesting that convenience to medical and nursing staff would not be greatly changed by elective induction of labour . There was no evidence that the hazards to mother and child were increased by elective induction , and its use might improve perinatal mortality by reducing the number of unexplained mature stillbirths Nine hundred fifteen of 2171 pregnant patients had no indication for ultrasound at their first prenatal visit and were r and omly assigned to receive either a single routine screening ultrasound or usual prenatal care . The estimated date of confinement was altered in 24.9 % of routine-ultrasound patients and in 11.6 % of usual-care patients through ultrasound examinations obtained for a subsequent clinical indication . Of these , 8.3 % of routine-ultrasound and 5.2 % of usual-care patients had gestational age errors of 2 weeks or more . There were no differences between the groups in inductions for post- date s pregnancy ( 7.0 versus 7.5 % ; P=.87 ) , total inductions ( 22.6 versus 24.9 % ; P=.61 ) , or adverse perinatal outcomes ( 6.7 versus 8.3 % ; P=.63 ) . Both sets of twins were detected in the screened group . In the usual-care group , five of seven pairs of twins ( 71 % ) were diagnosed by 24 weeks'gestation . There was no benefit found from routine ultrasound as performed in this study A r and omized prospect i ve clinical trial of induction of labor  at 42 completed weeks gestation versus expectant management in post date s pregnancies was performed . The primary screening test was the 24-hr urinary estriol creatinine ratio . The cesarean section rate was high in both groups and did not differ statistically . Intervention by delivery at 42 weeks decreased the development of small for gestational age infants , but costs slightly more . Twenty-four-hour urinary estriol creatinine ratio determinations predicted fetal distress in labor , but could not predict postmaturity syndrome or infants who were small for gestational age . As expectant management did not differ from induction of labor at 42 weeks from the st and point of maternal outcome , and as the cost difference was small , induction of labor at 42 weeks may be the preferred management as it improves infant outcome The influence of nipple stimulation ( NS ) at term on the duration of pregnancy was investigated among low-risk gravidas in a r and omized prospect i ve study . A significant inverse relationship was found between the duration of pregnancy and both gestational age at recruitment and cervical ( Bishop ) score , although the influence of cervical score was quantitatively small . Nipple stimulation did not influence either the duration of pregnancy or the probability of having a cesarean section or an instrumental delivery . Patient compliance was , however , poor , which may in part account for these findings , as there was an inverse trend between the daily average duration of NS  and the duration of pregnancy Three hundred two low-risk obstetric patients with an unfavorable cervical examination and well-established gestational age of at least 287 days were r and omly selected for management by either antepartum fetal testing or prostagl and in gel cervical ripening followed by aggressive induction of labor and delivery . The patients managed by induction of labor had a lower incidence of meconium-stained amniotic fluid , meconium aspiration , low Apgar scores , postmaturity syndrome , fetal distress , and cesarean delivery than did patients managed with antepartum fetal testing . Our data suggest that prostagl and in gel  cervical ripening and induction of labor and delivery by 42 weeks ' gestation may be the most appropriate management for patients with well-established gestational age and an unfavorable cervical examination In a prospect i ve r and omized study spontaneous and oxytocin induced labor have been compared with respect to duration of labor and the condition of the fetus and the newborn infant . The study consists of 166 normal patients at full term . No significant differences between the two groups were found , and the results of the study showed that induction of labor between the 40th and 41st week of pregnancy was safe for the fetus . It is concluded that there seems to be no increased risks to mother or fetus from induction of labor compared to normal labor provided that there is cephalic presentation and a normal pregnancy A non-aggressive approach to the management of post- date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less . Date s had been established with certainty in each case . In half of the patients ( the study group ) no time limit was imposed on the pregnancy , but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following : fetal movement count recorded daily by the mother , an  oxytocin challenge test  , and  amnioscopy .  The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score . In the 78 control patients labor was induced surgically on day 294 , even if the pelvic score was low . In the study group , labor started spontaneously in 52 patients ; labor was induced in 17 women after they showed an elevated pelvic score , in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed . There were 7 cesarean sections in the study group compared with 16 in the control group ( P less than 0.05 ) . The average duration of labor was 6.7 h in the study group , compared with 9.4 h in the control ( P less than 0.01 ) . There was no significant difference between the two groups with regard to meconium staining during labor , pathologic fetal heart rate , or the 5 min Apgar score . In the study group there was one neonatal death as a result of severe congenital heart disease , and in the control group one infant died due to asphyxia . It is concluded that conservative management of prolonged pregnancies , with close supervision , gives better results than routine induction of labor at 42 wk . The importance of the pelvic score as an indication for induction is stressed . A protocol has been developed which can be used in cases of uncertain date s as well OBJECTIVE To determine the cost-effectiveness of induction of labour versus serial fetal monitoring while awaiting spontaneous labour in postterm pregnancies . DESIGN Cost-effectiveness and cost-minimization analyses conducted as part of a Canadian multicentre r and omized clinical trial . SETTING Twenty-two Canadian hospitals , of which 19 were teaching hospitals and 3 were community hospitals . PATIENTS Women with uncomplicated pregnancies of 41 or more weeks ' gestation were r and omly assigned to induction of labour or serial antenatal monitoring .  Of the 3418 women enrolled , no data were received on 11 . Therefore , results were based on data from 1701 women in the induction arm of the study and 1706 women in the monitoring arm . MAIN OUTCOME MEASURES Perinatal mortality and neonatal morbidity , rates of cesarean section and health care costs . Hospital costing models were developed specifically for the study . Data on use of major re sources ( 
    Output:
    
This benefit is due to the effect of induction of labour after 41 weeks .
Routine induction of labour had no effect on caesarean section .
REVIEW ER 'S CONCLUSIONS Routine early pregnancy ultrasound examination and subsequent adjustment of delivery date appear to reduce the incidence of post-term pregnancy .
Routine induction of labour after 41 weeks gestation appears to reduce perinatal mortality .
There is not enough evidence to evaluate the effects of breast and nipple stimulation , or tests of fetal wellbeing