***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 To evaluate the efficacy of intravaginal prostagl and in E1 methyl analogue misoprostol in cervical ripening in patients with unfavorable cervix ( Bishop score < 4 ) requiring labor induction . METHOD A r and omized controlled clinical trial of 62 women in the third trimester with various indications for induction of labor were r and omly allocated to receive either 100 micrograms misoprostol inserted vaginally ( 32 ) or placebo similarly applied ( 30 ) . Transvaginal sonography was performed to measure the cervical length before and 12 hrs after insertion . RESULTS The mean change in cervical length and Bishop score was significantly greater in the misoprostol group ( 24 mm and score 8) compared with in the placebo group ( 2.2 mm and score 1 ) ( p = 0.001 ) . All but one patients receiving misoprostol  went into labor while only one in the placebo group did so . The interval from insertion to vaginal delivery was significantly shorter in the misoprostol group ( 12.0 vs 25.5 hrs , p < 0.001 ) . Delivery occurred within 24 hrs in 75 % and 30 % of patients in the misoprostol and placebo groups respectively . Uterine tachsystole occurred more frequently in the misoprostol group ( 38 % ) than in the placebo group ( 0 % ) ( p < 0.001 ) . All could be rapidly reversed by tocolytics without apparent untoward intrapartum effects . No significant differences were noted in the 2 groups in terms of perinatal outcomes and mode of delivery . CONCLUSION Intravaginal misoprostol is an effective , cheap and safe method for cervical ripening . The higher frequency of uterine tachysystole in the misoprostol group did not increase the risk of adverse intrapartum and neonatal outcomes 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 : 199 patients were used in a double blind placebo controlled trial testing the efficacy of prostagl and in E2 3 mg pessaries in the  induction of labour .  The trial showed that prostagl and in E2 pessaries were effective in the induction of labour  but that with only a 55 % success rate the results were less than that quoted by others . It was felt that the success rate could be increased by either reducing the time interval between insertion of the pessaries or by using a slow release vehicle for the prostagl and in . Surprisingly no significant shortening in the duration of labour was found between the  prostagl and in  group and the  placebo group , despite a significant increase in the favourability of the cervix in the prostagl and in pessary group . Also no factors were found which definitely distinguished between the success or failure of induction of labour using prostagl and in pessaries . It was felt that prostagl and in pessaries were a safe and reasonably effective method of induction of labour and that , with reduction in the time interval between insertion of pessaries or the use of a slow release vehicle for the prostagl and in , the efficacy would be greatly increased 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 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 Summary : We performed a prospect i ve r and omized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes ( PROM ) at term with early induction of labour or expectant management , 126 women with singleton pregnancy , cephalic presentation and gestational duration > 37 weeks , were r and omized either to immediate induction of labour with oxytocin ( Group 1 ) ( n= 52 ) , or conservative management ( Group 2 ) ( n=74 ) . Women who constituted Group 2 were divided into 2 groups . The first group ( Group 2A ) ( n=25 ) included women in whom spontaneous labour did not begin after a waiting period of 24 hours , in which case labour was induced with oxytocin i.e. expectant management . The second group consisted of women ( Group 2B ) ( n=49 ) in whom labour began spontaneously within 24 hours . The base Caesarean section rate was significantly higher in Group 2 ( 28.4 % ) ( p<0.05 ) . The rates of Caesarean section in the Groups 1–2A‐2B were 19.2 % , 60 % , and 12.2 % , respectively for nulliparous and parous women together . The rate of fetal distress was significantly higher in Group 2 ( p<0.05 ) . For determining maternal outcomes , the other parameters such as clinical chorioamnionitis , fever before or during labour , receiving antibiotics before or during labour , postpartum fever , analgesia , anaesthesia did not differ in Groups 1 and 2 . Women in Group 1 went into active labour sooner , had fewer digital vaginal examinations , had a shorter interval between membrane rapture and delivery , and spent less time in the hospital before delivery than those in Group 2 ( p<0.05 ) . Babies in Group 2 were more likely to receive  antibiotics  , and more likely to stay in an intensive care nursery for more than 24 hours , and more likely to receive ventilation after initial resuscitation than those babies in Group 1 . For developing apnoea and hypotonia , there was no significant difference between Groups 1 and 2 . However , for babies in Group 2A there was a significant difference . We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section , compared with a practice of expectant management . Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity In a r and omised double-blind trial 10 of 30 patients given 2 mg of intravaginal purified porcine relaxin on the evening before surgical induction of labour went into labour before the proposed induction . Of 30 control patients , none went into labour . Of the 30 patients treated with relaxin , 25 had improved cervical scores after treatment and significantly fewer required augmentation in labour with intravenous oxytocin than the control group . Administration of relaxin was associated with very little increase in uterine activity and no side-effects . The trial shows that exogenous relaxin causes cervical ripening and can initiate parturition . Endogenous relaxin may have a similar role Premature rupture of the membranes ( PROM ) in otherwise uncomplicated full-term single pregnancies was studied in a prospect i ve r and omized study . Ninety-three women were r and omized to either  induction with oxytocin infusion ( n = 43 ) or expectant management ( n = 50 ) . Twenty-four and 26 respectively were nulliparas . In the induction group , all but 3 were delivered within 24 h from PROM . There were 3 vacuum extraction s ( VE ) , all in nulliparous women . No  cesarean section ( CS ) was performed . In the expectancy group , 23 of 50 were delivered within 24 h. There were 5 VE and 3 CS in nulliparas and 1 VE and 1 CS in paras . The instrumental actions were mainly due to arrest of 1st or 2nd stage labor . The only clinical infections occurred in nulliparas in the expectancy group . Our conclusion is that parous women with PROM can be treated by either induction or expectancy while in nulliparas , induction after some hours ' expectation seems preferable 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 
    Output:
    
INTERPRETATION The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations .
There were benefits for the fetus and no increased risk of maternal death