***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: Seven hundred fifty-nine of 926 women in abnormal labor ( 82 % ) were entered into an open r and omized trial to compare the effects of oxytocin and saline .  Patients were classified as having either primary dysfunctional labor or secondary arrest of cervical dilatation . The end points chosen were an increase in the rate of cervical dilatation or a change in cervical dilatation . Patients who failed to respond to the initial solution were crossed over to the other solution .  Oxytocin was significantly superior to saline  in treating both labor abnormalities . Administration of oxytocin  did not increase the need for cesarean delivery for fetal distress OBJECTIVE To estimate the effect of epidural analgesia on the Friedman labor curve . METHODS This study was a secondary analysis of a previously reported r and omized trial of the effects of patient‐controlled epidural analgesia during labor compared with patient‐controlled meperidine on cesarean delivery rate . All subjects had a singleton , cephalic , nonanomalous fetus at or beyond 37 weeks ' gestation . This secondary analysis was limited to women who had cervical dilatation commencing of at least 3 cm ( ie , active phase of labor ) . RESULTS A total of 459 women were r and omized . Twenty‐five women were excluded for a cervix less than 3 cm dilated , leaving 220 women allocated to patient‐controlled epidural analgesia and 214 to patient‐controlled intravenous meperidine available for analysis . There were no significant demographic differences between the two groups , including age , race , gestational age , and cervix on admission . The active phase of labor was 1 hour longer in the epidural‐treated group ( 6.0 ± 3.2 hours versus 5.0 ± 3.2 hours , P < .001 ) . The rate of cervical dilation was significantly less with epidural analgesia ( 1.4 cm/h versus 1.6 cm/h , P < .002 ) . The duration of the second stage tended to be longer in the epidural group ( 1.1 ± 1.5 hours versus 0.9 ± 1.0 hours , P = .079 ) . CONCLUSION Epidural analgesia prolonged the active phase of labor by 1 hour compared with Friedman 's original criteria 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 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 To establish the spontaneous miscarriage rate and compare it with the procedure related miscarriage rate for amniocentesis and chorionic villus sampling ( CVS ) by experienced operators 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 Background Rates of caesarean section are progressively increasing in many parts of the world . As a result of psychosocial factors there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section  to ask for this procedure in China . A critical examination of this issue in relation to maternal outcomes is important . At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women . To fill the gap left by trials , this indication-matched cohort study was carried out to examine prospect ively the outcomes of  caesarean section  on women with no absolute obstetric indication compared with similar women who had vaginal delivery . Methods An indication-matched cohort study was undertaken to compare maternal outcomes following caesarean section with those undergoing vaginal delivery , in which the two groups were matched for non-absolute indications . 301 nulliparous women with caesarean section were matched successfully with 301 women who delivered vaginally in the Maternal and Children 's Hospitals ( MCHs ) in Shanghai , China . Logistic regression model or binomial regression model was used to estimate the relative risk ( RR ) directly . Adjusted RRs were calculated adjusting for propensity score and medical indications . Results The incidence of total complications was 2.2 times higher in the caesarean section group during hospitalization post-partum , compared with the vaginal delivery group ( RR = 2.2 ; 95 % CI : 1.1 - 4.4 ) . The risk of haemorrhage from the start of labour until 2 hours post-partum was significantly higher in the caesarean group ( RR = 5.6 ; 95 % CI : 1.2 - 26.9 ) . The risk of chronic abdominal pain was significantly higher for the caesarean section group ( RR = 3.6 ; 95 % CI : 1.2 - 10.9 ) than for the vaginal delivery group within 12 months post-partum . The two groups had similar incidences of anaemia and complicating infections such as wound complications or urinary tract infection . Conclusions In nulliparous women who were at low risk , caesarean section was associated with a higher rate of post-partum morbidity . Those requesting the surgical procedure with no conventional medical indication , should be advised of the potential risks OBJECTIVE Our purpose was to determine the effect of epidural analgesia on  nulliparous labor and delivery .  STUDY DESIGN Normal term nulliparous women in early spontaneous labor were r and omized to receive either narcotic or epidural analgesia . RESULTS When compared with the group receiving narcotic analgesia ( n = 45 ) , the group receiving epidural analgesia ( n = 48 ) had a significant prolongation in the first and second stages of labor , an increased requirement for oxytocin augmentation , and a significant slowing in the rate of cervical dilatation . Epidural analgesia was associated with a significant increase in malposition ( 4.4 % vs 18.8 % , p < 0.05 ) . Cesarean delivery occurred more frequently in the epidural group ( 2.2 % vs 25 % , p < 0.05 ) , primarily related to an increase in cesarean section for dystocia ( 2.2 % vs 16.7 % , p < 0.05 ) . CONCLUSIONS In a r and omized , controlled , prospect i ve trial epidural analgesia result ed in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery , primarily related to dystocia Objective . To show that early discontinuation of oxytocin will not increase the mean duration of the active labor phase in a clinical ly significant way . Design . Controlled non‐inferiority study . Setting . Department of Obstetrics and Gynecology , University of Caen , Clémenceau Hospital , France . Population . A total of 138 women with singleton pregnancy and a vertex presentation of over 34 gestational weeks , presenting a medical indication of induction of labor or a dystocia at onset of labor , from May 2005 to June 2006 . Methods . Two parallel groups were compared : continuation of oxytocin until delivery versus discontinuation of oxytocin at the onset of the active phase . The clinical ly acceptable increase in mean duration of the active phase of labor ( non‐inferiority margin ) was set at 60 minutes . Main outcome measures . Primary outcome measure was duration of the active labor phase . Secondary outcome measures included total duration of labor , parameters concerning oxytocin use , rates of uterine hyperstimulation and fetal heart rate ( FHR ) abnormalities , and mode of delivery . Some neonatal outcomes were also analyzed . Results . Equivalence of the two strategies ( continuation vs. discontinuation of oxytocin ) was not demonstrated ( p = 0.97 testing for non‐inferiority ) , the active phase even being significantly longer by a mean of 113 minutes ( p = 0.0001 testing for superiority ) . The rates of cesarean sections , alterations of FHR and delivery hemorrhage were higher when oxytocin was continued , but not significantly . There were significantly more infants hospitalized in neonatology when oxytocin was continued ( p = 0.028 ) . Conclusions . Discontinuation of oxytocin at the onset of the active phase prolongs labor . We found no argument for discontinuing the infusion of oxytocin at the onset of the active phase Background Oxytocin is widely used to speed up slow labour , especially in nulliparous women , but r and omised trials , apart from one reported only in abstract , have been too small to exclude important effects OBJECTIVE Our goal was to evaluate whether active management of labor lowers cesarean section rates , shortens the length of labor , and overcomes any negative effects of epidural analgesia on nulliparous labor . STUDY DESIGN We r and omly assigned 405 low-risk term nulliparous patients to either an  active management of labor ( n = 200 ) or our usual care control protocol ( n = 205 ) 
    Output:
    
There was no statistically significant difference identified between women in spontaneous labour with epidural analgesia who were augmented with oxytocin , compared with those who received placebo .