***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: ABSTRACT : To study the effect of antenatal indomethacin or nylidrin hydrochloride treatment on the fetal and neonatal ductus arteriosus and tricuspid valve function , 84 pregnant women with threatened premature birth between 22.9 and 34.0 wk gestation and 94 of their offspring born at 24.7 to 41.6 wk of gestation were studied by Doppler echocardiography . Forty-six women were treated with indomethacin and 38 with nylidrin .  Both peak systolic and peak diastolic velocities in the ductus increased after administration of indomethacin and exceeded the corresponding velocities in the fetuses of the nylidrin group ( p = 0.0001 ) . Ductal constriction occurred in 42 of 49 fetuses treated with indomethacin ( 86 % ) . Tricuspid valve regur-gitation ( TR ) was evident in 11 of 49 fetuses treated with indomethacin ( 22 % ) . The mean gestational age of the fetuses with TR ( 30.0 wk ) tended to be higher than those without TR ( 28.3 wk , p = 0.056 ) . In the nylidrin group , no fetus had ductal constriction or TR . A significant increase in peak systolic velocity ( r = 0.54 , p = 0.0001 ) and in peak diastolic velocity ( r = 0.46 , p = 0.0001 ) in the ductus with advancing gestational age was demonstrated in the indomethacin group ; however , in the nylidrin group , there was a less remarkable increase in peak systolic velocity ( r = 0.35 , p = 0.04 ) and no increase in peak diastolic velocity ( r = 0.02 , p = 0.93 ) . In infants born at or before 35 wk gestation , incidences of both spontaneous closure and in-domethacin-induced closure of ductus were similar in both study groups ( p > 0.1 ) . Ductal reopening tended to occur more frequently after indomethacin ( 17 % ) than after nylidrin ( 0 % ) administration ( p = 0.15 ) . These findings indicate that : 1 ) the fetal ductus becomes more reactive to indomethacin with increasing gestational age ; 2 ) TR tends to occur in fetuses with advanced gestational age ; and 3 ) prenatal exposure of indomethacin does not decrease the need for patent ductus arteriosus treatment in premature infants Preterm premature rupture of membranes ( PPROM ) complicates 3 % of pregnancies and frequently results in preterm birth , often within 48 hours of membrane rupture . Our objective was to determine if subjects with PPROM between 24 and 31 (6)/ ( 7 ) weeks ' gestation benefit from a 48-hour course of prophylactic indomethacin tocolysis . This was a double-masked r and omized controlled trial . Subjects with PPROM between 24 and 31 (6)/ ( 7 ) weeks ' gestation were r and omized to receive indomethacin or placebo for 48 hours in addition to corticosteroids and latency antibiotics . The primary outcome of the study was delivery within 48 hours . Maternal and neonatal outcomes were also compared . This study was concluded prematurely due to slow accrual after a total of 50 subjects were enrolled . A total of 23/25 ( 92 % ) subjects in the indomethacin group remained pregnant beyond 48 hours compared with 20/22 ( 90.9 % ) in the placebo group ( relative risk , 1.01 ; 95 % confidence interval , 0.84 to 1.21 ) . The latency period medians and interquartile ranges were similar between the two groups [ indomethacin 193 ( 92 to 376.5 ) hours versus placebo 199 ( 77.5 to 459 ) hours , P = 0.91 ] , and no differences were noted in any maternal or neonatal secondary outcomes . This limited study demonstrates no benefit with the use of prophylactic indomethacin tocolysis for women with PPROM The aim of this r and omized study was to compare the neonatal outcome in infants who have been exposed in utero to indomethacin  with that in infants exposed to a beta-adrenergic agonist , nylidrin hydrochloride . Eighty pregnant women threatened with preterm labor between 24 and 34 weeks of gestation were enrolled in the study . An intravenous infusion of nylidrin or enterally administered indomethacin was given for a maximum of 72 hours . If preterm labor recurred , all parturient patients were treated with nylidrin . Indomethacin  prolonged gestation significantly more than the beta-adrenergic agonist ( 6.6 weeks vs 4.5 weeks ; p = 0.04 ) . Ten of the forty-two infants exposed to indomethacin and 2 of the 45 infants exposed to nylidrin had bronchopulmonary dysplasia ( 24 % vs 5 % ; p = 0.02 ) . Among the 28 infants delivered within 120 hours after the start of treatment , the incidences of respiratory distress syndrome ( 82 % vs 29 % ; p = 0.02 ) , bronchopulmonary dysplasia ( 73 % vs 6 % ; p = 0.0006 ) , and necrotizing enterocolitis or focal intestinal perforation ( 27 % vs 0 % ; p = 0.03 ) were higher among those exposed to indomethacin than among those exposed to nylidrin . We infer that administration of indomethacin to pregnant women threatened with premature labor is associated with an increased risk of bronchopulmonary dysplasia in their infants if delivery occurs early Purpose : To assess the efficacy and safety of outpatient oral sulindac given until 34 weeks gestation to prevent the recurrence of preterm labor ( PTL ) . Material s and Methods : Women were considered c and i date s for the study if they had an episode of preterm labor successfully treated with inpatient parenteral tocolysis , intact membranes , cervical dilatation < 4 cm , and gestations < 34 weeks . C and i date s for the study were r and omized by the pharmacy to receive either a " look-alike " placebo or sulindac , 100 mg po bid until 34 weeks gestation . The patient was seen for follow-up visits at 1 week and then every other week until 34 weeks . On follow-up visits hourly fetal urine production , amniotic fluid assessment , and ductal velocities were obtained . Results : Forty-four patients were r and omized ( 21 sulindac and 23 placebo ) . All demographic and clinical variables were similar with the weeks at r and omization 29.2 and 30.5 in the sulindac and placebo groups , respectively . Readmission for tocolysis occurred in 5 and 3 of the sulindac and placebo group patients , respectively ( P = NS ) . Twenty and 22 of the sulindac and placebo group , respectively , delivered after 7 days . Amniotic fluid index in the sulindac group at 1 week was significantly lower than in the placebo group at 10.6 vs 13.0 . All neonatal outcome variables were similar between the groups , including birth weights , Apgar , cord pH , and total NICU days . Conclusion : Sulindac until 34 weeks gestation following successful tocolysis results in no apparent prolongation of gestation OBJECTIVE To compare the effectiveness and adverse effects of nifedipine versus indomethacin in the treatment of preterm labor . METHODS In a r and omized clinical trial , 79 women with labor pain at 26 - 33 weeks of gestation were treated with either oral nifedipine ( n=40 ) or rectal indomethacin ( n=39 ) . RESULTS Twenty-three ( 59 % ) women in the indomethacin group , and 10 ( 25 % ) in the nifedipine group did not respond to treatment ( P=0.002 ) . None of the 16 and 30 women remaining in the indomethacin and nifedipine groups , respectively , delivered during the subsequent 48 hours . Of these remaining women , 1 ( 6.25 % ) in the indomethacin group and 4 ( 13.3 % ) in the nifedipine group delivered between 48 hours and 7 days ( P=0.162 ) . For the women who responded to treatment , the mean gestational age at time of delivery was 238.5±19.4 days and 246.4±15.4 days in the nifedipine and indomethacin groups , respectively ( P=0.182 ) . Seventeen ( 42.5 % ) women in the nifedipine group , and 11 ( 28.2 % ) in the indomethacin group showed adverse effects ( P=0.184 ) . CONCLUSION Indomethacin was less effective than nifedipine for the fast treatment of preterm labor . For women who responded to treatment within 2 hours , however , the delaying of delivery by indomethacin was similar to that by nifedipine Objective To compare the efficacy of intravaginal and intra-rectal plus oral indomethacin for the treatment of preterm labor . Methods Between December 1996 and November 1998 , 46 eligible gravidas admitted with singleton pregnancies and idiopathic preterm labor before 33 gestational weeks were r and omized to receive 200 mg of intravaginal or intrarectal plus oral indomethacin . Results Twenty-three subjects were allocated to each study group .  The interval from initiation of treatment to delivery was significantly longer in the intravaginal indomethacin group ( 26.5 ± 5.7 versus 12.6 ± 3.7 days ; P = .007 ) . Delivery was delayed by more than 7 days in 18 of 23 subjects ( 78 % ) in the intravaginal indomethacin group compared with ten ( 43 % ) in the intrarectal plus oral indomethacin group ( P = .03 ) . Birth weights were significantly higher ( 2306 ± 436 versus 1862 ± 232 g ; P = .002 ) and hospitalization in a neonatal intensive care unit ( NICU ) ( 3.1 ± 0.8 versus 9.3 ± 3.7 days ; P = .001 ) and mechanical ventilation ( 1.4 ± 0.2 versus 5.3 ± 1.6 days ; P = .001 ) were significantly shorter in the intravaginal indomethacin group . Conclusion Intravaginal indomethacin is more effective than intrarectal plus oral application in delaying preterm labor and is associated with higher birth weights , shorter NICU stays , and shorter intervals of mechanical ventilation OBJECTIVE Our purpose was to evaluate the relative efficacy and safety of indomethacin versus magnesium sulfate in the management of  preterm labor in pregnancies < 32 weeks of gestation . STUDY DESIGN Eligible patients admitted with singleton pregnancies and idiopathic preterm labor between August 1988 and October 1989 were r and omized by sealed envelopes to receive either indomethacin or intravenous magnesium sulfate . RESULTS Of 101 eligible patients 49 were r and omized to receive indomethacin .  The two study groups were similar in regard to a number of entry variables , including gestational age , cervical examination , and contraction frequency .  Indomethacin was as effective as magnesium sulfate in delaying delivery > 48 hours , 90 % versus 85 % , and together with oral terbutaline in extending the gestation , 22.9 versus 22.7 days . Tocolysis with magnesium sulfate was discontinued in eight ( 15 % ) patients because of maternal side effects , in contrast to none in the indomethacin group , p < 0.05 . CONCLUSION For gestations < 32 weeks indomethacin may be considered an appropriate alternative to magnesium sulfate as a first-time tocolytic agent Using data collected as a follow-up to a r and omized trial , Melissa Gladstone and colleagues show that during the first two years of life , infants born preterm in southern Malawi are disadvantaged in terms of mortality , growth , and development One hundred six patients in preterm labor with intact amniotic membranes and gestational age less than or equal to 32 weeks were r and omized to receive either ritodrine hydrochloride or a 48-hour course of indomethacin for tocolysis . The relative efficacy , maternal and neonatal safety , and costs were evaluated to determine which may be the more appropriate first-line pharmacologic agent used to manage preterm labor . Fifty-four patients and 52 patients were r and omized to receive ritodrine hydrochloride or indomethacin  , respectively .  Ritodrine hydrochloride and indomethacin were equally effective in inhibiting uterine contractions and delaying delivery . Delivery was delayed for at least 48 hours in 83 and 94 % , and for at least 7 days in 70 and 75 % of patients receiving ritodrine or indomethacin , respectively . Tocolysis with indomethacin was associated with no maternal side effects , whereas tocolysis with ritodrine hydrochloride was associated with 
    Output:
    
No difference was shown in measures of neonatal morbidity or neonatal mortality .
Compared with betamimetics , COX inhibitors result ed in a reduction in birth less than 48 hours after trial entry ( RR 0.27 , 95 % CI 0.08 to 0.96 ; NNTB 7 , 95 % CI 6 to 120 ; two studies with 100 women ) and preterm birth ( before completion of 37 weeks of gestation ) ( RR 0.53 , 95 % CI 0.28 to 0.99 ; NNTB 6 , 95 % CI 4 to 236 ; two studies with 80 women ) although no benefit was shown in terms of neonatal morbidity or mortality .
AUTHORS ' CONCLUSIONS In this review , no clear benefit for COX inhibitors was shown over placebo or any other tocolytic agents .