***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: The authors have carried out a r and om study on 75 cases in order to evaluate objective ly the therapeutic methods usually employed in cases of dystocia in starting labour . These studies have shown the superiority of Syntocinon using an infusion together with epidural analgesia . This attitude goes against the methods of treatment usually used in France . The authors explain the reasons for their choice in the light of factors that they have observed using other therapeutic methods Objective To compare labour outcomes using aggressive or expectant management protocol OBJECTIVE To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients . METHODS The charts of 255 women r and omized to active management of labor ( n = 125 ) or control protocol s ( n = 130 ) were review ed and stratified to early epidural placement ( up to 4 cm cervical dilatation ) versus late placement ( more than 4 cm ) . RESULTS Women with early epidural placement had shorter labors than those with late placement ( 11.6 + /- 4.6 versus 13.2 + /- 5.6 hours ; P = .02 ) . Active management reduced the length of labor compared with controls regardless of epidural timing , with a reduction of 1.4 hours in early epidural placement ( 10.9 + /- 4.7 versus 12.3 + /- 4.3 hours ; P = .04 ) and 3.6 hours in those with later placement ( 11.0 + /- 3.6 versus 14.6 + /- 6.2 hours ; P = .004 ) . Cesarean rates did not vary significantly ( early 14.5 % versus late 7.9 % ; P = .21 ) . Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates . CONCLUSION Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement .  Women managed actively in labor , regardless of timing of epidural placement , had shorter labors than controls BACKGROUND Active management of labor reduces the length of labor and rate of prolonged labor , but its effect on satisfaction with care , within a r and omized controlled trial , has not previously been reported . The study objectives were to establish if a policy of active management of labor affected any aspect of maternal satisfaction , and to determine the independent explanatory variables for satisfaction with labor care in a low-risk nulliparous obstetric population . METHODS Nulliparous women at National Women 's Hospital in Auckl and , New Zeal and , in spontaneous labor at term with singleton pregnancy , cephalic presentation , and without fetal distress were r and omized after the onset of labor to active management ( n = 320 ) or routine care ( n = 331 ) .  Active management included early amniotomy , two-hourly vaginal assessment s , and early use of high dose oxytocin for slow progress in labor . Routine care was not prespecified . Maternal satisfaction with labor care was assessed by postal question naire at 6 weeks postpartum . Sensitivity analyses were performed , and logistic regression models were developed to determine independent explanatory variables for satisfaction . RESULTS Of the 651 women r and omized in the trial , 482 ( 74 % ) returned the question naires . Satisfaction with labor care was high ( 77 % ) and did not significantly differ by treatment group . This finding was stable when sensitivity analysis was performed . The first logistic regression model found independent associations between satisfaction and adequate pain relief , one-to-one midwifery care , adequate information and explanations by staff , accurate expectation of length of labor , not having a postpartum hemorrhage , and fewer than three vaginal examinations during labor . The second model found fewer than three vaginal examinations and one-to-one midwifery care as significant explanatory variables for satisfaction with labor care . CONCLUSIONS Active management did not adversely affect women 's satisfaction with labor and delivery care in this trial . Future studies should concentrate on measurement of potential predictors before and during labor The objective of our study was prospect ively compare the effect in the rate of cesarean section of active labor management and of traditional labor management in primiparas with physiological term pregnancy . From september 1 , 1993 to may 31 , 1994 , 145 primiparas with physiological term pregnancy were r and omly assigned to one group of active labor management ( study group , n = 75 ) and to one group of traditional labor management ( control group , n = 70 ) . Cesarean section rate was 9.3 % in the study group and 20 % in the control group ( p < 0.05 ) . There was no increase in fetal morbidity or mortality .  Active labor management can reduce cesarean section rate in primiparas with physiological term pregnancy OBJECTIVE To compare the costs of a protocol of active management of labor with those of traditional labor management . DESIGN Cost analysis of a r and omized controlled trial . METHODS From August 1992 to April 1996 , we r and omly allocated 405 women whose infants were delivered at the University of New Mexico Health Sciences Center , Albuquerque , to an active management of labor protocol that had substantially reduced the duration of labor or a control protocol .  We calculated the average cost for each delivery , using both actual costs and charges . RESULTS The average cost for women assigned to the active management protocol was $ 2,480.79 compared with an average cost of $ 2,528.61 for women in the control group ( P = 0.55 ) . For women whose infant was delivered by cesarean section , the average cost was $ 4,771.54 for active management of labor and $ 4,468.89 for the control protocol ( P = 0.16 ) . Spontaneous vaginal deliveries cost an average of $ 27.00 more for actively managed patients compared with the cost for the control protocol . CONCLUSIONS The reduced duration of labor by active management did not translate into significant cost savings . Overall , an average cost saving of only $ 47.91 , or 2 % , was achieved for labors that were actively managed . This reduction in cost was due to a decrease in the rate of cesarean sections in women whose labor was actively managed and not to a decreased duration of labor Objective To assess the risks and benefits associated with  caesarean delivery compared with vaginal delivery . Design Prospect i ve cohort study within the 2005 WHO global survey on maternal and perinatal health . Setting 410 health facilities in 24 areas in eight r and omly selected Latin American countries ; 123 were r and omly selected and 120 participated and provided data Participants 106 546 deliveries reported during the three month study period , with data available for 97 095 ( 91 % coverage ) . Main outcome measures Maternal , fetal , and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery , adjusted for clinical , demographic , pregnancy , and institutional characteristics . Results Women undergoing caesarean delivery  had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery ( odds ratio 2.0 ( 95 % confidence interval 1.6 to 2.5 ) for intrapartum caesarean and 2.3 ( 1.7 to 3.1 ) for elective caesarean ) . The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries . With cephalic presentation , there was a trend towards a reduced odds ratio for fetal death with elective caesarean , after adjustment for possible confounding variables and gestational age ( 0.7 , 0.4 to 1.0 ) . With breech presentation , caesarean delivery had a large protective effect for fetal death . With cephalic presentation , however , independent of possible confounding variables and gestational age , intrapartum and  elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care ( 2.1 ( 1.8 to 2.6 ) and 1.9 ( 1.6 to 2.3 ) , respectively ) and the risk of neonatal mortality up to hospital discharge ( 1.7 ( 1.3 to 2.2 ) and 1.9 ( 1.5 to 2.6 ) , respectively ) , which remained higher even after exclusion of all caesarean deliveries for fetal distress . Such increased risk was not seen for breech presentation . Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery , but rupturing of membranes may be protective . Conclusions Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations The aim of this r and omised trial was to determine the effect of the policy of active management of labour in all its components on the rate of caesarean section in a Nigerian district hospital setting . Two hundred and twenty-one nulliparous women fulfilling selected inclusion criteria were r and omised to receive active management of labour , and 227 control women received routine labour management .  Labour was significantly shortened by over 2 hours with active management of labour , and caesarean section reduced ( 9 % vs. 16 % , RR 0.57 , 95 % CI 0.34 - 0.95 ) . There were no significant differences in maternal infectious morbidity , uterine hyperstimulation syndromes , ruptured uterus or neonatal Apgar scores between the two groups . We conclude that active management of labour  shortens primigravid labour  and reduces caesarean risk OBJECTIVE Much of fever during term labor may not be infectious but rather a consequence of the use of epidural analgesia . Therefore , we investigated the association of elevated maternal intrapartum temperature with neonatal outcome when the infant does not develop an infection . METHODS We studied 1218 nulliparous women with singleton , term pregnancies in a vertex presentation and spontaneous labor . Women were excluded if their temperature was > 99.5 degrees F at admission for delivery , if they were diabetic or had an active genital herpes infection or if their infant developed a neonatal infection , had a congenital infection , or had a major malformation . Maximum intrapartum temperature was categorized as : < /=100.4 degrees F ( afebrile ) , 100.5 degrees F to 101 degrees F , and > 101 degrees F. RESULTS During labor , 123 women ( 10.1 % ) developed a fever > 100.4 degrees F ; 62 ( 5.1 % ) women had a maximum temperature of 100.5 degrees F to 101 degrees F and 61 ( 5.0 % ) women had a maximum temperature > 101 degrees F. Of febrile women , 97.6 % had received epidural analgesia for pain relief . Infants of women developing a fever > 100.4 degrees F were more likely to have a 1-minute Apgar score < 7 ( 22.8 % for > 100.4 degrees F vs 8.0 % for afebrile ) and to be hypotonic after delivery ( 4.8 % for > 100.4 degrees F vs.5 % for afebrile ) . Compared with infants of afebrile women , infants whose mothers ' maximum temperature was > 101 degrees F were more likely to require  bag and mask resuscitation  ( 11.5 % vs 3.0 % ) and to be given  oxygen therapy  in the nursery ( 8.2 % vs 1.3 % ) . We also found a higher rate of neonatal seizure with fever ( 3.3 % vs.2 % ) , but the number of infants with seizure was small ( n = 4 ) . All associations remained essentially the same after controlling for confounding in logistic regression analyses . CONCLUSIONS Intrapartum maternal fever , particularly if > 101 degrees F , was associated with a number of apparently transient adverse effects in the newborn . Larger studies are needed to investigate the association of intrapartum fever with neonatal seizures and to determine whether any lasting injury to the fetus may occur BACKGROUND Over the past two decades , the rate of cesarean section in the United States has risen from 5 percent to 25 percent of deliveries , primarily because of the increased frequency of dystocia ( arrest of labor ) . One strategy that has been proposed for increasing the rate of vaginal delivery is a program of active management of labor that encourages early amniotomy , early diagnosis of slow progress in labor , and the use of higher than usual doses of oxytocin ; the efficacy and safety of this approach are uncertain , however . METHODS We conducted a r and omized trial in which nulliparous women in spontaneous labor at term were r and omly assigned to either active management of labor or traditional management . With active management , amniotomy was performed within one hour of the diagnosis of labor , and when the rate of cervical dilation was less than 1 cm per hour , oxytocin was infused at an initial rate of 6 mU per minute . The dose was increased by 6 mU per minute every 15 minutes ( to a maximum of 36 mU per minute ) until there were seven contractions every 15 minutes . RESULTS For the women assigned to active management ( n = 351 ) , the cesarean-section rate was 10.5 percent , as compared with 14.1 percent for those assigned to traditional management ( n = 354 , P = 0.18 ) . The 26 percent reduction in the cesarean-section rate was due primarily to a decrease in dystocia . After we controlled for potential confounding variables , the reduction in the rate of delivery by cesarean section was statist 
    Output:
    
Active management is associated with small reductions in the CS rate , but it is highly prescriptive and interventional .
It is possible that some components of the active management package are more effective than others .