***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 test the hypothesis that high-dose oxytocin , when used in a masked fashion , would result in shorter labors and less need for cesarean delivery . METHODS We conducted r and omized , double-masked trials of high-dose compared with low-dose oxytocin for augmentation and induction of labor . Patients were r and omly assigned to receive oxytocin by either a low-dose protocol ( 1.5 mU/minute initially , increased by 1.5 mU/minute every 30 minutes ) or a high-dose protocol ( 4.5 mU/minute initially , increased by 4.5 mU/minute every 30 minutes ) . Oxytocin solutions were prepared by a central pharmacy and infusion volumes ( mL/hour ) were identical , thus ensuring double masking . RESULTS A total of 1307 patients were r and omized ( induction , 816 ; augmentation , 491 ) . In the group receiving oxytocin for induction , high-dose oxytocin was associated with a significant shortening of labor ( oxytocin to complete dilatation : 9.7+/-0.3 compared with 7.8+/-0.2 hours , P<.001 ; oxytocin to delivery : 10.5+/-0.3 compared with 8.5+/-0.3 hours , P<.001 ) . The cesarean delivery rate with low-dose oxytocin was 15.0 % , compared with 11.3 % with high-dose oxytocin ( P = .17 ) . For nulliparous women undergoing induction , cesarean delivery rates were as follows : Total 17.3 % ( low dose ) compared with 11.7 % ( high dose ) , P = .15 ; cephalopelvic disproportion 11.9 % ( low dose ) compared with 5.9 % ( high dose ) , P = .06 . When used for augmentation , high-dose oxytocin again was associated with a significant shortening of labor without a significant difference in cesarean birth rates . No differences in neonatal outcomes were noted between the groups for either augmentation or induction . CONCLUSION When used in a double-masked fashion , high-dose oxytocin is associated with significantly shorter labors without any demonstrable adverse fetal or neonatal effects STUDY OBJECTIVE : To determine the extent of intrapartum intervention received by primigravidas . DESIGN : Cross sectional survey of NHS hospitals in the UK . SETTING : One hundred and one r and omly selected hospital maternity units . PARTICIPANTS : Forty consecutive primigravid women , judged to be at low risk at the start of labour , in each hospital . MAIN OUTCOME MEASURES : Seven groups of interventions or monitoring procedures were identified from the first , second , and third stages of labour : fetal monitoring , vaginal examinations , artificial rupture of membranes , augmentation of labour , pain relief , type of delivery , and episiotomy . Data were collected during 1993 . MAIN RESULTS : Ninety eight hospitals took part in the study and data were collected on 3160 low risk primigravidas . Seventy four per cent of these women had continuous cardiotocography . The proportion of women having restrictive or invasive fetal monitoring showed appreciable geographical variation for both the first and second stages of labour . Using the criterion of a vaginal examination every four hours and allowing for the length of each woman 's labour , 72 % had more vaginal examinations than expected ; there was a significant geographical variation in the number of women receiving more than five examinations . Fifty three per cent had artificial rupture of membranes ; the procedure was performed over a wide range of cervical dilatations ( 0 cm-10 cm ) . Thirty eight per cent of labours were augmented , most commonly by intravenous syntocinon ; the procedure showed significant geographical variation . Twenty eight per cent had a spinal block or epidural analgesia for the relief of pain ; this intervention varied by geographical region only for the second stage of labour . Over one quarter of the women required instrumental delivery . Forty six per cent had an episiotomy ; the frequency of this intervention varied substantially by region . There were no infant deaths . Twelve babies were recorded at birth as having a congenital anomaly . CONCLUSIONS : The rates of several interventions seem high for this low risk group and there was substantial geographical variation in the use of six interventions . Clinical trials are needed to evaluate the optimum criteria for using these interventions from which guidelines should be drawn up by local groups and the Royal College OBJECTIVE To compare high and low starting dose of oxytocin infusion for effectiveness and safety in augmentation of labour in nulliparous women . DESIGN An open r and omised controlled clinical trial . SETTING Harare Maternity Hospital , Zimbabwe . SUBJECTS 258 nulliparous women , with spontaneous onset of labour , who required augmentation . MAIN OUTCOMES MEASURES Duration of augmentation , mode of delivery , maternal and neonatal complications . INTERVENTIONS Women were r and omly allocated to either low dose ( starting at 4 mIU/minute ) or high dose ( starting at 10 mIU/minute ) oxytocin group . RESULTS Of the 258 women enrolled , 133 were r and omized to the low and 125 to the high starting oxytocin dose groups . The groups were comparable for maternal and gestational age . There was no difference in mean cervical dilatation before augmentation of labour ; six cm in both groups ( p = 0.167 ) . The mean augmentation to delivery interval was shorter in the high dose group , 218 versus 326 minutes ( p < 0.001 ) . There was no difference in the mode of delivery and fetal outcome in terms of birthweight , five minute Apgar score , admission to neonatal unit and perinatal death . CONCLUSION A high starting dose of oxytocin infusion is as safe but more effective for augmentation of labour in nulliparous women , compared to a low starting dose OBJECTIVE Our purpose was to perform a r and omized trial comparing intravaginal misoprostol to intravaginal prostagl and in E2 gel for preinduction cervical ripening evaluating efficacy and side effects . STUDY DESIGN Seventy-five women seen for induction of labor were r and omized to receive 100 micrograms of intravaginal misoprostol or 5 mg of pharmacy-prepared intravaginal prostagl and in E2 gel for cervical ripening before oxytocin induction . Six hours after placement of the study agent , patients were given oxytocin if they were not in labor . The primary outcome measure was induction-to-delivery time ; secondary measures were change in Bishop score , delivery mode , and side effects . Results were analyzed by the Student t test and Fisher 's exact test , with p < 0.05 considered significant . RESULTS There was no difference in the incidence of primiparity or the median initial Bishop score between the two study groups . The mean time to delivery and the need for oxytocin  was significantly less for subjects receiving misoprostol . There was no difference in the incidence of uterine hyperstimulation syndrome or cesarean delivery between the groups . CONCLUSIONS This r and omized clinical trial indicates that misoprostol is efficacious for preinduction cervical ripening . Misoprostol use result ed in a significantly shorter induction-to-delivery time compared with prostagl and in E2 gel use . The side effects associated with misoprostol may be dose related , and further studies to identify the optimum dosage and interval are needed Objective : To compare two low-dose oxytocin protocol s in terms of fetal distress , uterine hyperstimulation , cesarean delivery rate , maximum dose of oxytocin , and length of labor . Methods : We r and omized 865 patients into 15-minute ( incremental dose 1 mU/minute until 5 mU/minute , then 1 or 2 mU/minute ) or 40-minute ( incremental dose 1.5 mU/minute until 7 mU/minute , then 1.5 or 3.0 mU/minute ) low-dose protocol s. Before oxytocin use , all subjects were stratified according to parity and purpose of oxytocin , ie , for induction or augmentation of labor . Results : The 40-minute dosing protocol had a significantly lower maximum dose of oxytocin  ( augmentation , 6.5 versus 8.2 mU/minute , P < .001 ; induction , 11.5 versus 14.5 mU/minute , P < .001 ) , a lower incidence of uterine hyperstimulation ( augmentation , 18.8 versus 31.8 % , P < .001 ; induction , 19.1 versus 33.0 % , P < .002 ) , and less fetal distress ( augmentation , 15.5 versus 26.1 % , P < .005 ) . No significant differences were found in the cesarean rate or length of labor . Conclusion : A dosing interval of 40 minutes led to lower incidences of uterine hyperstimulation and fetal distress , and decreased the maximum dose of oxytocin , without affecting the length of labor or the cesarean rate Objective : To determine whether an increase in the oxytocin dosing interval would decrease the incidence of uterine hypers timulation . Methods : This study included 1801 consecutive pregnancies receiving high-dose oxytocin . Oxytocin was used for labor augmentation in 1167 and induction in 634 women . Twenty- and 40-minute dosage intervals were compared . The study period was based on an 80 % likelihood of detecting S and 10 % differences in the cesarean and hyperstimulation rates , respectively . Statistics were analyzed with X1 , Fisher , and Wilcoxon rank-sum tests where appropriate . Multivariate logistic regression and analysis of covariance were used to control for confounding demographic variables . Results : Comparison of the 20- and 40-minute regimens for labor induction yielded no differences in the rates of cesarean delivery for dystocia ( 16 versus 19%% ) or fetal distress ( 5 versus 6 % ) . The 20-minute regimen for augmentation was associated with a significant reduction in cesarean for dystocia ( 8 versus 12 % P=.05 ) . The incidence of uterine hyperstimulation was greater with the 20-minute than the 40-minute regimen for induction ( 40 versus 31 % P=.02 ) , but not for augmentation ( 31 versus 28 % ) . Neonatal outcomes were unaffected by the dosage interval for both augmentation and induction . Conclusion : A 40-minute dosing interval for high-dose oxytocin offers no clear advantage over a 20-minute interval . Both regimens were safe and efficient , with no differences in perinatal outcome . The 20-minute interval was associated with fewer cesareans for dystocia when used for labor augmentation , whereas the 40-minute interval result ed in less hyperstimulation when used for labor induction . ( Obstet Gynecol 1994;83:234r4 OBJECTIVE To compare the efficacy and safety of high dose oxytocin in the augmentation of labor . METHOD Two hundred pregnant women requiring augmentation of labor were r and omly assigned to receive oxytocin by either a low dose protocol ( 1.5 microm/min initially , increased by 1.5 microm/min every 30 min ) or a high dose protocol ( 4.5 microm/min initially , increased by 4.5 microm/min every 30 min ) . RESULTS High dose of oxytocin was associated with a significant shortening of labor 4 ( 1.10 - 10 ) vs. 6 ( 1 - 10 ) h , p<0.0001 without a significant difference in cesarean delivery rate , neonatal and maternal outcome . CONCLUSION The use of high dose oxytocin is associated with significantly shorter labor without any adverse fetal and maternal effects OBJECTIVE Our purpose was to compare the efficacy and safety of low-dose versus high-dose oxytocin regimens in the augmentation of labor . STUDY DESIGN Three hundred ten term pregnancies requiring augmentation of labor underwent r and omization to receive either a low-dose or high-dose oxytocin augmentation regimen .  Maternal demographics , labor-delivery data , and neonatal outcome were compared . RESULTS The high-dose oxytocin group had a significantly lower cesarean section rate , regardless of parity ( 10.4 % vs 25.7 % , p < 0.001 ) , with no differences in maternal complications and neonatal outcomes . The time needed to correct the labor abnormality was also significantly decreased ( 1.24 + /- 1.4 hours vs 3.12 + /- 1.6 hours , p < 0.001 ) in the high-dose group . CONCLUSIONS The use of high-dose oxytocin regimen benefits both nulliparous and multiparous women requiring labor augmentation  by significantly lowering both the time necessary to correct the labor abnormality and the need for cesarean section Uterine activity was measured in 60 women whose first labour was progressing slowly in the active phase . The mean level of active contraction area ( uterine activity integral , UAI ) before oxytocin augmentation was 898 ( SD 458 ) kPas/15 min . UAI increased significantly with time , even in women not given oxytocin .  UAI increased logarithmically with increasing oxytocin infusion rate . Levels of uterine activity before and after oxytocin infusion are correlated positively such that the higher the initial level of UAI the higher the UAI in response to oxytocin . However , the regression line approaches the 
    Output:
    
When we carried out sensitivity analysis ( temporarily removing a study at high risk of bias ) the differences between groups were no longer statistically significantThere were no significant differences between high- and low-dose regimens for instrumental vaginal birth , epidural analgesia , hyperstimulation , postpartum haemorrhage , chorioamnionitis or women 's perceptions of experiences .
For neonatal outcomes , there was no significant difference between groups for Apgar scores , umbilical cord pH , admission to special care baby unit , or neonatal mortality .
AUTHORS ' CONCLUSIONS Higher-dose regimens of oxytocin ( 4 mU per minute or more ) were associated with a reduction in the length of labour and in caesarean section , and an increase in spontaneous vaginal birth .