***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 : Background Around 80 % of intrauterine growth restricted ( IUGR ) infants are born at term . They have an increase in perinatal mortality and morbidity including behavioral problems , minor developmental delay and spastic cerebral palsy . Management is controversial , in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance . We propose a r and omised trial to compare effectiveness , costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term . Methods / design The proposed trial is a multi-centre r and omised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36 + 0 and 41 + 0 weeks . After informed consent women will be r and omly allocated to either induction of labour or expectant management with maternal and fetal monitoring . R and omisation will be web-based . The primary outcome measure will be a composite neonatal morbidity and mortality . Secondary outcomes will be severe maternal morbidity , maternal quality of life and costs . Moreover , we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry ( Child Behavioral Check List-CBCL and Ages and Stages Question naire-ASQ ) . Analysis will be by intention to treat . Quality of life analysis and a preference study will also be performed in the same study population . Health technology assessment with an economic analysis is part of this so called Digitat trial ( Disproportionate Intrauterine Growth Intervention Trial At Term ) . The study aims to include 325 patients per arm . Discussion This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality , costs and maternal quality of life aspects . This will be the first r and omised trial for IUGR at term . Trial registration Dutch Trial Register and IS RCT N-Register : IS RCT N10363217 Objectives : In low-risk pregnancies , the management of oligohydramnios is not clear . The aim of this study was to compare maternal and neonatal outcomes in cases of isolated oligohydramnios r and omised to either induction of labour or expectant management . Methods : 87 women pregnant beyond 40 completed weeks were asked to participate in the study . Fifty-four accepted and were r and omised at 288 days of pregnancy . Twenty-six were r and omised to expectant management and 28 to induction of labour . The primary maternal outcome was the mode of delivery and the primary neonatal outcomes were cord blood pH and Apgar score at delivery . Results : No significant differences were found for any important maternal or neonatal outcome . Conclusion : Based on these results , the decisions about management could be individualised . Even though the number of patients included was small , these results are well in concordance with others 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 Background Hypertensive disorders , i.e. pregnancy induced hypertension and preeclampsia , complicate 10 to15 % of all pregnancies at term and are a major cause of maternal and perinatal morbidity and mortality . The only causal treatment is delivery . In case of preterm pregnancies conservative management is advocated if the risks for mother and child remain acceptable . In contrast , there is no consensus on how to manage mild hypertensive disease in pregnancies at term . Induction of labour might prevent maternal and neonatal complications at the expense of increased instrumental vaginal delivery rates and caesarean section rates . Methods / Design Women with a pregnancy complicated by pregnancy induced hypertension or mild preeclampsia at a gestational age between 36 + 0 and 41 + 0 weeks will be asked to participate in a multi-centre r and omised controlled trial . Women will be r and omised to either induction of labour or expectant management for spontaneous delivery . The primary outcome of this study is severe maternal morbidity , which can be complicated by maternal mortality in rare cases . Secondary outcome measures are neonatal mortality and morbidity , caesarean and vaginal instrumental delivery rates , maternal quality of life and costs . Analysis will be by intention to treat . In total , 720 pregnant women have to be r and omised to show a reduction in severe maternal complications of hypertensive disease from 12 to 6 % . Discussion This trial will provide evidence as to whether or not induction of labour in women with pregnancy induced hypertension or mild preeclampsia ( nearly ) at term is an effective treatment to prevent severe maternal complications . Trial Registration The protocol is registered in the clinical trial register number IS RCT N08132825 Abstract Aim : To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes ( PROM ) and an unfavorable cervix . Methods : We r and omized 130 women with PROM of ≤4 h to either  oral misoprostol  , 50 μg , or a placebo given every 4 h for up to three doses . Intravenous oxytocin was initiated if active labor did not begin within 12 h. Results : Sixty-four women received oral misoprostol and 66 received placebo .  The PROM-to-delivery interval was shorter with misoprostol than with placebo ( 13.7±5.8 vs. 20.3±6.8 h , respectively , P<0.05 ) . Misoprostol significantly reduced the need for oxytocin  ( 28.1 vs. 72.7 % , P<0.001 ) and antibiotics ( 25 vs. 69.7 % , P<0.001 ) . No significant differences in cesarean section or hyperstimulation rate were noted . Conclusion : Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics BACKGROUND Although delivery is widely used for preterm babies failing to thrive in utero , the effect of altering delivery timing has never been assessed in a r and omised controlled trial . We aim ed to compare the effect of delivering early with delaying birth for as long as possible . METHODS 548 pregnant women were recruited by 69 hospitals in 13 European countries . Participants had fetal compromise between 24 and 36 weeks , an umbilical-artery doppler waveform recorded , and clinical uncertainty about whether immediate delivery was indicated . Before birth , 588 babies were r and omly assigned to immediate delivery ( n=296 ) or delayed delivery until the obstetrician was no longer uncertain ( n=292 ) . The main outcome was death or disability at or beyond 2 years of age . Disability was defined as a Griffiths developmental quotient of 70 or less or the presence of motor or perceptual severe disability . Analysis was by intention-to-treat . This trial has been assigned the International St and ard R and omised Controlled Trial Number IS RCT N41358726 . FINDINGS Primary outcomes were available on 290 ( 98 % ) immediate and 283 ( 97 % ) deferred deliveries . Overall rate of death or severe disability at 2 years was 55 ( 19 % ) of 290 immediate births , and 44 ( 16 % ) of 283 delayed births . With adjustment for gestational age and umbilical-artery doppler category , the odds ratio ( 95 % CrI ) was 1.1 ( 0.7 - 1.8 ) . Most of the observed difference was in disability in babies younger than 31 weeks of gestation at r and omisation : 14 ( 13 % ) immediate versus five ( 5 % ) delayed deliveries . No important differences in the median Griffiths developmental quotient in survivors was seen . INTERPRETATION The lack of difference in mortality suggests that obstetricians are delivering sick preterm babies at about the correct moment to minimise mortality . However , they could be delivering too early to minimise brain damage . These results do not lend support to the idea that obstetricians can deliver before terminal hypoxaemia to improve brain development Clinical practice guidelines have improved in quality over the past 10 years by adhering to a few basic principles , such as conducting thorough systematic review s of relevant evidence and grading the recommendations and the quality of the underlying evidence . The large number of systems of measuring the quality of evidence and recommendations that have emerged are , however , confusing.1 The mission of the Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) working group is to help resolve the confusion among the different systems of rating evidence and recommendations . The group has wide representation from many organisations including the Agency for Healthcare Research and Quality in the US , the National Institute for Clinical Excellence for Engl and and Wales , and the World Health Organization . Developing a new uniform rating system is challenging because all systems have limitations and because many organisations have invested a great deal of time and effort to develop their rating systems and are underst and ably reluctant to adopt a new system . The GRADE working group first published the results of its work in 2004 in the BMJ.2 A simpler , clinical ly oriented description will soon be published.3 GRADE has taken care to ensure its suggested system is simple to use and applicable to a wide variety of clinical recommendations that span the full spectrum of medical specialties and clinical care . The GRADE system classifies recommendations in 1 of 2 levels — strong and weak— and quality of evidence into 1 of 4 levels — high , moderate , low , and very low . Evidence based on r and omised controlled trials ( RCTs ) begins with a top rating on GRADE ’s 4 level quality of evidence classification ( table Objective To compare the effectiveness of  immediate induction of labour with vaginal misoprostol versus expectant management for 24 hours followed by oxytocin induction in women with prem 
    Output:
    
Recommendations for induction of labour for post-term gestation , PROM at term , and premature rupture of membranes near term with pulmonary maturity are supported by the evidence .
Induction for IUGR before term reduces intrauterine fetal death , but increases caesarean deliveries and neonatal deaths .
Evidence is insufficient to support induction for women with insulin-requiring diabetes , twin gestation , fetal macrosomia , oligohydramnios , cholestasis of pregnancy , maternal cardiac disease and fetal gastroschisis .
AUTHORS ' CONCLUSIONS Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications