***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 
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    ***EXAMPLES*** 
    Input: Background The question about outcome in twins delivered early versus late remains unanswered . The objective of this study was to evaluate the association of the timing of delivering twins and the perinatal outcome . Methods A prospect i ve cohort study was carried-out in Alex and ria University Maternity Hospital . We planned to examine the records of twin deliveries over 2 years . The inclusion criteria were twin deliveries with gestational age at delivery at least 36 completed weeks . Twins of mothers with chronic illness and those with congenital anomalies were excluded . Perinatal outcome parameters ( morbidity and mortality ) were defined and evaluated . Results Out of 273 twin sets , 197 ( 72.2 % ) met the inclusion criteria . They were classified into 3 groups according to the gestational age at delivery . Neonatal morbidity and maternal complications were higher in those delivered earlier . Twins electively delivered had worse outcome than those delivered spontaneously . In the elective group , there was no difference in the outcome between those delivered earlier or later . Conclusion Twins , when the pregnancy is uncomplicated , continue to grow and mature with advancement of the gestational age . In the absence of significant maternal complications , it is advisable to deliver twins only at 38 completed weeks ' gestation or later to avoid neonatal complications OBJECTIVE To clarify the safety of elective induction of labor at 39 weeks of gestation . STUDY DESIGN Prospect i ve r and omized study . SUBJECTS AND METHODS Uncomplicated nulliparas ( N = 194 ) were r and omly assigned at 36 weeks of gestation . Labor was electively induced in 63 women at 39 weeks of gestation in the active management group ( I group , N = 98 ) . Spontaneous labor onset was expected with semi-weekly nonstress test ( NST ) and amniotic fluid index ( AFI ) by 42 weeks of gestation in the expectant group ( E group , N = 96 ) . Perinatal events were compared between the 2 groups . RESULTS A significantly higher incidence of meconium-stained amnios ( 19.4 % vs 3.2 % ) and fetal resuscitation ( 16.7 % vs 4.8 % ) was found in the E group than in the I group . Also , although a significantly higher incidence of epidural analgesia was noted in the I group ( 89 % ) than in the E group ( 54 % ) ( labor onset > or = 39 weeks , N = 72 ) , the duration of the 1st stage was shorter in I group and the duration of the 2nd stage was not significantly different . No other significant difference was noted between the 2 groups in terms of the rate of C-section , blood loss , incidence of pathological FHR , birth weight , Apgar score , umbilical arterial pH , or admission to NICU . CONCLUSION Active management of labor at 39 weeks could be made as safely as expectant management with modified biophysical profile monitoring 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 Netherl and s between October , 2005 , and March , 2008 . We enrolled patients with a singleton pregnancy at 36 - 41 weeks ' gestation , and who had gestational hypertension or mild pre-eclampsia . Participants were r and omly allocated in a 1:1 ratio by block r and omisation with a web-based application system to receive either induction of labour or expectant monitoring . Masking of intervention allocation was not possible . The primary outcome was a composite measure of poor maternal outcome --maternal mortality , maternal morbidity ( eclampsia , HELLP syndrome , pulmonary oedema , thromboembolic disease , and placental abruption ) , progression to severe hypertension or proteinuria , and major post-partum haemorrhage ( > 1000 mL blood loss ) . Analysis was by intention to treat and treatment effect is presented as relative risk . This study is registered , number IS RCT N08132825 . FINDINGS 756 patients were allocated to receive induction of labour ( n=377 patients ) or expectant monitoring  ( n=379 ) . 397 patients refused r and omisation but authorised use of their medical records . Of women who were r and omised , 117 ( 31 % ) allocated to induction of labour developed poor maternal outcome compared with 166 ( 44 % ) allocated to expectant monitoring ( relative risk 0.71 , 95 % CI 0.59 - 0.86 , p<0.0001 ) . No cases of maternal or neonatal death or eclampsia were recorded . INTERPRETATION Induction of labour is associated with improved maternal outcome and should be advised for women with mild hypertensive disease beyond 37 weeks ' gestation . FUNDING ZonMw A prospect i ve r and omized controlled trial design ed to investigate selective planned delivery is reported : 264 obstetrically normal women in the 38th week of pregnancy were admitted to this trial and 184 completed it . The infants of mothers in the planned delivery group had higher serum bilirubin levels on the fifth day post partum than control infants but no baby required treatment for hyperbilirubinaemia . Mothers in the planned delivery group required significantly greater amounts of pethidine  while control mothers had a significantly higher incidence of meconium staining of the amniotic fluid . However , the infants in the two groups had similar Apgar scores at birth . There was one stillbirth in the control group ; this was due to unrecognized fetal hypoxia during labour induced at 42 weeks for postmaturity Abstract . In a prospect i ve r and omized study spontaneous and oxytocin induced labor “ for convenience ” have been compared with respect to uterine activity , duration of labor , the condition of the fetus and the newborn infant . The study consists of 84 normal patients , of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II ; 41 patients served as controls . No difference in maternal age , number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups . The following parameters were calculated : duration of labor , uterine activity , amount of bleeding in the third stage of labor , number of early and late decelerations as well as number of episodes of bradycardia in the CTG‐recordings , birth weight , Apgar score one and five minutes post‐delivery and blood gases in mother and child 60 seconds after delivery . No significant differences between the two groups were found . It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy , careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring The effect of induction of labor on the neonatal bilirubin levels was investigated in a prospect i ve r and omized study . Forty‐three infants born after elective induction with oxytocin using the Cardiff infusion system and 38 infants born after spontaneous delivery were studied . Several factors other than oxytocin administration which could influence the bilirubin levels such as gestational age , placental transfusion and feeding routines did not differ between the two groups . There were no differences with regard to pH in umbilical vein , Apgar scores , haemoglobin and erythrocyte volume fractions or bilirubin levels neonatally . Thus there was no evidence of an association between induction of labor with oxytocin  and jaundice during the neonatal period 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 Objective . To determine if elective induction ( IND ) increases the risk of cesarean delivery compared to expectant management ( EM ) . Methods . A r and omized clinical trial involving women ⩾39 weeks ' gestation , according to strict dating criteria , with a Bishop score of 5 or more in nulliparous patients and 4 or more in multiparous patients . The control group was expectantly managed and delivered for obstetric indications , but not later than 42 weeks ' gestation . The study had 80 % power to detect a three-fold increase in cesarean delivery . Results . One-hundred- and -sixteen patients ( 45 nulliparous ) were r and omized to IND and 110 ( 58 nulliparous ) to EM . Demographic characteristics were no different between the groups . The cesarean delivery rate in the IND group was 6.9 % ( 8/116 ) compared to 7.3 % ( 8/110 ) in the EM group ( p = NS ) . Rates of cesarean delivery for nulliparous patients r and omized to IND compared to EM were also not significantly different : 13.3 % ( 6/45 ) versus 10.3 % ( 6/58 ) respectively ( p = NS ) . Neonates delivered of IND patients weighed less than those of the EM group ( 3459 ± 347 versus 3604 ± 438 , p = 0.006 ) . Conclusion . In women with favorable Bishop scores , elective induction of labor result ed in no increase in cesarean delivery compared to expectant management Objective : The appropriate date of delivery in twin pregnancies is supposed to be earlier than that in singleton pregnancy . The aim of this study was to compare two strategies for managing twin pregnancies  ( i.e. , immediate induction and expectant management ) . Methods : Seventeen patients underwent immediately induced labor by administration of oral prostagl and in E2 at 37 weeks , while 19 patients underwent expectant management .  Results : The average gestational age at delivery in the induction group was 37.5 ± 0.4 weeks , significantly earlier than that in the expectant management group ( 39.0 ± 1.1 weeks ) . However , there were no significant differences in the average birth weight between the two groups ( 2,700 ± 330 g in the induction group vs. 2,672 ± 392 g in the expectant management group ) . The cesarean delivery rate in the induction group was 18 % , not significantly different from that in the expectant management group ( 32 % ) . The most common indication for cesarean section in the expectant management group was maternal infection , while there was no maternal infection in the induction group ( p = 0.08 ) . Conclusion : It may be acceptable do intervene in twin pregnancies earlier than in singleton pregnancies during term OBJECTIVE To test the hypothesis that in pregnancies with a clinical ly suspected growth restricted foetus at term , induction of labour is as safe as expectant management , and does not lead to increased obstetrical interventions or perinatal morbidity . STUDY DESIGN In one obstetric centre , 33 women with a clinical ly suspected growth restricted foetus at term were r and omly allocated after stratification for parity to either induction or to expectant management . Obstetric and neonatal outcome variables were compared . RESULTS There was a lower gestational age at labour ( median 38(0 ) weeks versus 40(1 ) weeks ) with a corresponding tendency to lower birth weight ( mean 2428 g versus 2651 g ) , and a reduced need for ante partum medical surveillance , in the induction group . No significant differences in obstetrical interventions ( 25 % versus 24 % ) and neonatal morbidity rates ( 50 % versus 35 % ) were found . CONCLUSION A larger multicenter study with a sufficient power and long-term follow-up to decide the best policy for the term growth restricted foetus is feasible Objective Macrosomia at term is associated with increased maternal and neonatal morbidity , including a higher rate of cesarean delivery and shoulder dystocia . Induction of labor has been suggested as a means to prevent further weight gain and improve outcome . The aim of this study was to determine whether or not induction of labor in these cases improves maternal and neonatal outcome . Methods Patients at term with an ultrasonic fetal weight estimation of 4000 - 4500 g were prospect ively r and omized into two groups :  induction of labor ( group I ) and expectant management ( group II ) . Patients with diabetes , a previous cesarean delivery , or nonvertex presentation were excluded . Outcome variables included mode of delivery , arterial cord pH , presence of shoulder dystocia , brachial plexus injury , clavicular fracture , cephalophematoma , and intraventricular hemorrhage . Results Of 273 patients who were eligible for the study , 134 were r and omized to group I and 139 to group II .  Parity , gestational age , and fetal weight estimation were similar in the two groups . The neonates of group II patients were significantly heavier ( 4132.8  
    Output:
    
Planned delivery at 37 weeks in twins is associated with a similar risk of cesarean delivery and lower risk of serious adverse infant outcomes , compared to expectant management until at least 38 weeks