***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 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 : 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 OBJECTIVE : To estimate the association between delivery preferences during pregnancy and actual delivery mode . METHODS : This was a prospect i ve cohort study using data from the Norwegian Mother and Child Cohort Study ( N=65,959 ) . We analyzed predictors of birth outcome by means of women 's preferences for mode or delivery and a range of medical and socioeconomic factors with multivariable logistic regression models . The term “ elective ” cesarean delivery includes cesarean deliveries planned 8 hours or more before delivery and performed as planned . RESULTS : When asked about delivery preference at 30 weeks of gestation , 5 % of the women reported a preference for a cesarean delivery  , 84 % had a preference for vaginal delivery , and 11 % were neutral . Among those with a cesarean delivery preference , 48 % subsequently had a  cesarean delivery  ( 12 % acute and 36 % elective ) , and of those with a vaginal preference 12 % delivered by  cesarean  ( 8.7 % acute and 3.1 % elective ) . When adjusting for maternal characteristics and medical indications , the odds for an acute cesarean delivery among nulliparous women with a cesarean delivery preference was almost two times higher ( odds ratio [ OR ] 1.97 , 95 % confidence interval [ CI ] 1.49–2.62 ) and for elective cesarean delivery  the preference was 12 times higher ( OR 12.61 , 95 % CI 9.69–16.42 ) than for women with a vaginal preference . For multiparous women , the corresponding figures were OR 3.13 ( 95 % CI 1.39–7.05 ) and OR 10.04 ( 95 % CI 4.59–21.99 ) . When multiparous women with previous cesarean deliveries were excluded , the OR for an elective cesarean delivery  was 26 times higher given a cesarean delivery preference compared with a vaginal delivery preference ( OR 25.78 , 95 % CI 7.89–84.28 ) . Based on a small subset of women with planned cesarean delivery on maternal request ( n=560 ) , we estimated a predicted probability of 16 % for nulliparous women ( 25 % for multiparous women ) for such cesarean delivery . CONCLUSION : Pregnant women 's expressed preferences for delivery mode were associated with both elective and acute cesarean deliveries . LEVEL OF EVIDENCE : OBJECTIVE To study the cesarean rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix . STUDY DESIGN A total of 249 women with uncomplicated pregnancies at 41 weeks plus 3 days ( 290 days ) with favorable cervix ( Bishop score > or = 6 ) were r and omized to either expectant management ( n=125 ) or immediate induction of labor ( n=124 ) . The women in the induction group were sent to labor ward for induction by artificial rupture of membranes ( ARM ) and /or oxytocin infusion . The women with expectant management had nonstress test ( NST ) and amniotic fluid index ( AFI ) performed once a week and twice a week after 43 weeks of gestation until spontaneous labor . RESULTS The cesarean rate was not different between expectant management and immediate induction ( 21.6 % versus 26.6 % ; P=0.36 ) . Ninety-five percent of the expectant group delivered within 1 week after enrollment , and all of them delivered within 9 days after r and omization . Maternal and fetal complications in both groups were not different . There was also no difference in the mean birth weight ( P=0.24 ) and the frequency of macrosomia ( birth weight > or = 4000 g ) between the two groups ( P=0.23 ) . CONCLUSION Cesarean section rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix was not different . Due to the very low adverse perinatal outcome , both expectant management and immediate induction are acceptable OBJECTIVE To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up until 42 weeks and induction if the patient has still not given birth at 42 weeks . STUDY DESIGN Six hundred women at 287+/-1 days of gestation with definitely unfavorable cervical scores were r and omized to labor induction ( N=300 ) or spontaneous follow-up ( N=300 ) with twice-weekly nonstress testing and amniotic fluid measurement and once-weekly biophysical scoring . The treatments used in the induction group were ( 1 ) vaginal administration of 50 microg misoprostol ( n=100 ) , ( 2 ) oxytocin induction ( n=100 ) , and ( 3 ) transcervical insertion of a Foley balloon ( n=100 ) . The primary outcome measures were the cesarean delivery rate , whether or not the normal hospital stay had to be extended , and the neonatal outcomes . Secondary outcome measure included number of emergency cesarean deliveries performed for abnormalities of the fetal heart rate ( FHR ) . RESULTS The abdominal delivery rate was 19.3 % in the induction group and 22 % in the follow-up group ( p=0.4 ) . The mean length of hospital stay in the two main groups was 1.4+/-0.8 days and 1.3+/-1 days , respectively ( p=0.1 ) . Significantly higher rates of macrosomia and shoulder dystocia were seen in the follow-up group ( 24.6 and 2.3 % ) than in the induction group ( 7.6 % , p<0.001 ; 0.3 % , p=0.03 ) . Meconium-stained amniotic fluid and meconium aspiration syndrome were observed significantly less frequently in the induction group ( 9.3 and 1.3 % ) than in the follow-up group ( 20.3 % , p<0.001 ; 4 % , p=0.03 ) . Rates of emergency abdominal delivery in response to worrying FHR traces , neonatal intensive care unit admission , and low umblical artery pH were similar in the two groups . There was one intrauterine fetal death in the follow-up group . CONCLUSION Induction of labor at 41 weeks of gestation does not increase the cesarean delivery rate or cause a longer stay in hospital than follow-up until 42 weeks , and neonatal morbidity is also lower after induction 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 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 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 order to describe how  post-term pregnancy  was managed in Denmark , a question naire was sent to all 50 maternity departments with a 100 % response rate . Thirty-nine departments managed post-term pregnancy ; twenty-one departments conservatively ( i.e.expectantly ) and 18 departments with induction of labour .  Cardiotocography  in the surveillance of the foetus was routine in 35 departments ; 21 departments monitored with ultrasound and 18 used human placental lactogen .  Gestational age was confirmed by ultrasound before 20th week of gestation in nine of ten departments with > 2000 births per year , in four of 19 departments with 1000 - 2000 births per year , and in five of ten departments with < 1000 births per year . Ten departments which managed post-term pregnancy by induction did not routinely confirm gestational age by ultrasound . Danish obstetricians differ in their management of post term pregnancy . Cumulative data from prospect i ve , r and omized studies can be interpreted as showing an active policy of induction to be advantageous . A large multicentre study is difficult , but desirable in order out to discuss for and against induction or expectant management In a prospect i ve r and omised study of mothers referred for prolonged pregnancy ( around the 42nd week ) 214 ( group 1 ) were su bmi tted to attempted induction of labour  and 195 ( group 2 ) assigned to continue for a further week without intervention . Strict selection criteria were used for the certainty of term . Mothers in group 2 were given regular non-stress tests to ensure fetal wellbeing , as were those in group 1 in whom induction failed . In group 1 , 48 ( 23 % ) out of 210 first attempted inductions failed . In group 2 , 135 ( 69 % ) of the births started spontaneously as compared with 38 ( 18 % ) in group 1 . The mean 
    Output:
    
One factor provided moderate- quality evidence supporting elective induction policies in low-risk women .
There is moderate- quality evidence that-compared with expectant management-an induction policy is associated with a decrease in caesarean delivery rates in low-risk women .
There is significant caesarean delivery rate variation among Ontario hospitals