***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: Summary We combined real-time B-mode ultrasonography with a 2 MHz pulsed Doppler technique to record blood flow in the fetal descending aorta and in the intra-abdominal part of the umbilical vein in 14 pregnant women at term . The blood flow was studied before and after instillation into the vagina of either 4 mg prostagl and in E2 ( PGE2 ) gel or placebo gel . The PGE2 gel was significantly more effective in cervical priming and labor induction than the placebo gel . After instillation of the gel neither group showed a change in the fetal volume blood flow or in the aortic blood velocity waveform . We conclude that the instillation of 4 mg of PGE2 gel does not affect fetal hemodynamics at term Induction of labour is a common obstetric intervention . When the cervix is unfavourable ripening agents are used , commonly prostagl and in E2 . There are several methods of administration of prostagl and in E2 and little comparative work has been performed as to their acceptability by patients . Patients undergoing induction of labour by prostagl and in E2 were r and omised to receive either intravaginal gel or an intravaginal slow-release pessary .  Patient satisfaction with the method received was then assessed . Sixty-nine patients were r and omised , 34 to receive gel and 35 to receive a pessary .  Median scores for satisfaction of the induction process were the same for both methods ; however , satisfaction with the labour was increased with those who had been r and omised to the pessary group ( median pessary=5 , gel=4 ) . There may be a marginal improvement in patient satisfaction when a slow-release intravaginal prostagl and in E2 pessary is used for the induction of labour This study represents the first of its kind in Kuwait . Two preparations of prostagl and in E2 ( PGE2 ) have been compared as agents for induction of labor . In a r and omized controlled study of 200 women of low parity and unfavorable cervical induction features induction of labor by means of a single vaginal tablets of PGE2 was compared with locally prepared PGE2 vaginal pessaries . The gradual increase of uterine contractions and the establishment of labor in a similar way to that observed during spontaneous labor was more apparent after PGE2 tablets . Labor induction was successful in 80 % of patients in PGE2 tablet group compared with 59 % in PGE2 pessaries group . The incidence of cesarean section was equal in both groups ( 4 % ) , but none was performed due to uterine hyperactivity . The data presented indicate that the PGE2 vaginal tablet is safe and effective in induction of labor in healthy women at term The unfavorable cervix remains a major obstacle to the successful induction of labor . Reported are results from an ongoing study of topical prostagl and in preparations used to effect preinduction cervical ripening . The current study compares the efficacy of 40 mg of prostagl and in ( PG ) F2 alpha versus 5 mg of PGE2 , applied to the cervix in a methyltylose gel the night before attempted induction of labor . A prospect i ve double-blind protocol was used similar to that which previously established the efficacy of the 5 mg of PGE2 preparation versus placebo at this institution . Results indicate the superiority of the PGE2 preparation as measured by change in Bishop score , Pitocin requirement , rate of cervical dilatation , and percentage of failed inductions . Cesarean section rates were similar in the two study groups , and no fetal or maternal morbidity was attributable to the preinduction ripening technique 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 Two hundred consecutive women with uncomplicated pregnancies , at or within 4 days of their expected date of confinement , were prospect ively r and omized into 2 groups . One group had expectant management , with twice weekly surveillance tests , while the other group had 3 mg of vaginal prostagl and in E2 as outpatient treatment . There were 104 women in the expectant group and 70 in the induction group ( 26 women allocated to induction preferred no treatment ) . The average number of days to delivery was 1.6 in the induction group and 5.2 in the expectant group ( p < 0.001 ) . While meconium was much less frequent in the induction group ( p < 0.002 ) , all other outcome measures , including cesarean section rates , incidence of macrosomia , and Apgar scores , were similar in the two groups OBJECTIVE To compare the efficacy and safety of a prostagl and in E2 ( PGE2 ) vaginal insert with PGE2 administered as a vaginal tablet . STUDY DESIGN A r and omized , observational study was performed . Women requiring induction of labor were r and omly assigned to receive either a 10-mg PGE2 vaginal insert ( group 1 , n = 100 ) or 3-mg PGE2 tablets twice at six-hour intervals ( group 2 , n = 100 ) . The primary efficacy outcome variable was vaginal delivery within 24 hours of insertion . The criteria for safety were the occurrence of uterine hyperstimulation , abnormal fetal heart rate patterns , use of beta 2-sympathomimetic drugs and fetal outcome . RESULTS No differences in terms of vaginal delivery or cesarean section within 24 hours of induction were found . The cesarean section rate was 21 % in group 1 and 22 % in group 2 . The interval from insertion of the induction agent to the onset of regular uterine contractions and the insertion-to-delivery interval were not different between the two cohorts . No difference in the frequency of uterine hyperstimulation , use of beta 2-sympathomimetic drugs , abnormal fetal heart rate patterns , fetal outcome , or oxytocin and analgesic requirements were found . In seven of eight patients in group 1 who experienced uterine hyperstimulation , removal of the insert was sufficient to stop it , whereas in group 2 , of nine cases , eight needed medical interventions to end hyperstimulation ( P = .003 ) . CONCLUSION The continuous release of PGE2 from the vaginal insert permits controlled induction of labor , and easy removal of the drug in cases of uterine hyperstimulation is possible Summary In a r and omized double-blind study we evaluated the effects on cervical ripening and labor induction of 0.5 mg PGE2 in gel given intracervically and 2.0 mg PGE2 given as a vaginal suppository . All patients were at term with unfavorable cervical scores . The indications for induction were toxemia , diabetes mellitus , Rh-immunization , or intrauterine growth retardation . Significantly better results for both cervical priming and labor induction were obtained after intracervical PGE2-gel application than after treatment with placebo or vaginal suppositories .  Eleven out of 19 patients ( 58 % ) were delivered within 24 h after intracervical PGE2-gel compared to two out of 19 patients given placebo ( p < 0.01 ) . In patients not delivered 24 h after the start of treatment , the mean cervical score had changed from 3.7 to 6.0 ( p < 0.05 ) after PGE2-gel application compared to a change from 3.9 to 4.3 after placebo treatment ( n.s . ) . The outcome after treatment with PGE2 suppositories did not differ significantly from that with placebo treatment . In a subsequent study 25 patients were given 0.5 mg PGE2-gel intracervically . The results were consistent with those obtained in patients receiving PGE2-gel intracervically in the double-blind study .Few side effects were noted . No patient complained of gastro-intestinal discomfort but increased myometrial activity was observed in two patients ; one after placebo and the other after active intracervical PGE2-gel treatment . The hyperactivity was readily countered with the β2-agonist , terbutaline . All infants were born in good condition  with Apgar scores of 7 or more within 5 min . At pediatric examinations at 1 week and at 6 months of age all children seemed healthy BACKGROUND As the interval between rupture of the fetal membranes at term and delivery increases , so may the risk of fetal and maternal infection . It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another . METHODS We studied 5041 women with prelabor rupture of the membranes at term . The women were r and omly assigned to induction of labor with intravenous oxytocin ; induction of labor with vaginal prostagl and in E2 gel ; or expectant management for up to four days , with labor induced with either intravenous oxytocin or vaginal prostagl and in E2 gel if complications developed . The primary outcome was neonatal infection . Secondary outcomes were the need for cesarean section and women 's evaluations of their treatment . RESULTS The rates of neonatal infection and cesarean section were not significantly different among the study groups . The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group , 3.0 percent for the induction-with-prostagl and in group , 2.8 percent for the expectant-management ( oxytocin ) group , and 2.7 percent for the expectant-management ( prostagl and in ) group . The rates of cesarean section ranged from 9.6 to 10.9 percent . Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management ( oxytocin ) group ( 4.0 percent vs. 8.6 percent , P<0.001 ) , as was postpartum fever ( 1.9 percent vs. 3.6 percent , P=0.008 ) . Women in the induction groups were less likely to say they liked " nothing " about their treatment than those in the expectant-management groups . CONCLUSIONS In women with prelabor rupture of the membranes at term , induction of labor with oxytocin or prostagl and in E2 and expectant management result in similar rates of neonatal infection and cesarean section . Induction of labor with intravenous oxytocin results in a lower risk of maternal infection than does expectant management . Women view induction of labor more positively than expectant management OBJECTIVE The aim of our study was to evaluate the optimum dose of intravaginal prostagl and in E2 gel for induction for labor in nulliparous women with a relatively ripe cervix ( modified Bishop score 4 or 5 ) . METHOD One hundred and sixty-seven nulliparous women at term with indications for the induction of labor were treated r and omly with two doses of intravaginal 2.0 ( group A ) or 3.0 mg ( group B ) of prostagl and in PGE2 gel every 12 h. Data were analyzed by chi 2-test and Student 's t-test . RESULTS Of 87 patients 64 went into labor after gel application in group A , compared with 68/80 in group B ( 73.5 % vs. 85.0 % ) ( P = NS ) . A second gel administration was needed for 9 women in group A and 6 women in group B. More side effects ( both local and systemic ) were noted in group B than in group A ( 28.7 % vs. 14.9 % ) ( P = 0.03 ) . In particular , more local ( hyperstimulation or hypertonus ) side effects were noted in group B ( 13.7 % vs. 2.3 % ) ( P = 0.01 ) . CONCLUSION The vaginal administration of 2.0 mg of PGE2 gel seems to be equally effective as 3.0 mg in terms of labor success rate with a significant lower incidence of side effects The effect of low-dose prostagl and in E2 vaginal gel specially prepared from commercially available material s , on subsequent indicated oxytocin induction of labor , was investigated in a r and omized , double-blind , placebo-controlled clinical trial . The stability of the gel after preparation was documented by radioimmunoassay in vitro . No differences between the treated and placebo  groups were noted in subsequent modified Bishop scores , length of labor , use of analgesia or anesthesia , success of induction , mode of delivery , or perinatal outcome . Comparisons of this clinical trial with those previously reported are offered OBJECTIVE To compare two dosage regimens for the administration of vaginal prostagl and in gel in triacetin base for induction of labor . METHODS Seventy subjects planned for elective induction of labor at term were r and omized to treatment with PGE2 vaginal gel every 6 or 12 hours . The 6-hourly group received an initial dose of 1 mg , followed by 2 mg at 6 hour intervals for a maximum of two additional doses if not in active labor . The 12-hourly group had an initial dose of 2 mg followed by two additional doses at 12 hour intervals if not in active labor . RESULTS Successful induction rate was higher in the 12-hourly as compared to 6-hourly gel regimen ( 100 % vs. 91 % , P > 0.05 ) . Twelve hours after the 
    Output:
    
Overall , vaginal prostagl and in E2 compared with placebo or no treatment probably reduces the likelihood of vaginal delivery not being achieved within 24 hours .
The overall effect on improving maternal and fetal outcomes ( across a variety of measures ) is uncertain .
PGE2 tablets , gels and pessaries ( including sustained release preparations ) appear to be as effective as each other , small differences are detected between some outcomes , but these maybe due to chance .
Prostagl and ins PGE2 probably increase the chance of vaginal delivery in 24 hours , they increase uterine hyperstimulation with fetal heart changes but do not effect or may reduce caesarean section rates .
They increase the likelihood of cervical change , with no increase in operative delivery rates .