***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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    Input: Background Post-term pregnancy , a pregnancy exceeding 294 days or 42 completed weeks , is associated with increased perinatal morbidity and mortality and is considered a high-risk condition which requires specialist surveillance and induction of labour . However , there is uncertainty on the policy concerning the timing of induction for post-term pregnancy or impending post-term pregnancy , leading to practice variation between caregivers . Previous studies on induction at or beyond 41 weeks versus expectant management showed different results on perinatal outcome though conclusions in meta-analyses show a preference for induction at 41 weeks . However , interpretation of the results is hampered by the limited sample size of most trials and the heterogeneity in design . Most control groups had a policy of awaiting spontaneous onset of labour that went far beyond 42 weeks , which does not reflect usual care in The Netherl and s where induction of labour at 42 weeks is the regular policy . Thus leaving the question unanswered if induction at 41 weeks results in better perinatal outcomes than expectant management until 42 weeks . Methods / design In this study we compare a policy of labour induction at 41 + 0/+1 weeks with a policy of expectant management until 42 weeks in obstetrical low risk women without contra-indications for expectant management until 42 weeks and a singleton pregnancy in cephalic position . We will perform a multicenter r and omised controlled clinical trial . Our primary outcome will be a composite outcome of perinatal mortality and neonatal morbidity . Secondary outcomes will be maternal outcomes as mode of delivery ( operative vaginal delivery and Caesarean section ) , need for analgesia and postpartum haemorrhage ( ≥1000 ml ) . Maternal preferences , satisfaction , wellbeing , pain and anxiety will be assessed alongside the trial . Discussion This study will provide evidence for the management of pregnant women reaching a gestational age of 41 weeks . Trial registration Dutch Trial Register ( Nederl and s Trial Register ) : NTR3431 . Registered : 14 May 2012 Summary : We performed a prospect i ve r and omized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes ( PROM ) at term with early induction of labour or expectant management , 126 women with singleton pregnancy , cephalic presentation and gestational duration > 37 weeks , were r and omized either to immediate induction of labour with oxytocin ( Group 1 ) ( n= 52 ) , or conservative management ( Group 2 ) ( n=74 ) . Women who constituted Group 2 were divided into 2 groups . The first group ( Group 2A ) ( n=25 ) included women in whom spontaneous labour did not begin after a waiting period of 24 hours , in which case labour was induced with oxytocin i.e. expectant management . The second group consisted of women ( Group 2B ) ( n=49 ) in whom labour began spontaneously within 24 hours . The base Caesarean section rate was significantly higher in Group 2 ( 28.4 % ) ( p<0.05 ) . The rates of Caesarean section in the Groups 1–2A‐2B were 19.2 % , 60 % , and 12.2 % , respectively for nulliparous and parous women together . The rate of fetal distress was significantly higher in Group 2 ( p<0.05 ) . For determining maternal outcomes , the other parameters such as clinical chorioamnionitis , fever before or during labour , receiving antibiotics before or during labour , postpartum fever , analgesia , anaesthesia did not differ in Groups 1 and 2 . Women in Group 1 went into active labour sooner , had fewer digital vaginal examinations , had a shorter interval between membrane rapture and delivery , and spent less time in the hospital before delivery than those in Group 2 ( p<0.05 ) . Babies in Group 2 were more likely to receive  antibiotics  , and more likely to stay in an intensive care nursery for more than 24 hours , and more likely to receive ventilation after initial resuscitation than those babies in Group 1 . For developing apnoea and hypotonia , there was no significant difference between Groups 1 and 2 . However , for babies in Group 2A there was a significant difference . We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section , compared with a practice of expectant management . Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity BACKGROUND Macrosomic fetuses are at increased risk of shoulder dystocia . We aim ed to compare induction of labour with expectant management for large-for- date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia . METHODS We did this pragmatic , r and omised controlled trial between Oct 1 , 2002 , and Jan 1 , 2009 , in 19 tertiary-care centres in France , Switzerl and , and Belgium . Women with singleton fetuses whose estimated weight exceeded the 95th percentile , were r and omly assigned ( 1:1 ) , via computer-generated permuted-block r and omisation ( block size of four to eight ) to receive induction of labour within 3 days between 37(+0 ) weeks and 38(+6 ) weeks of gestation , or expectant management . R and omisation was stratified by centre . Participants and caregivers were not masked to group assignment . Our primary outcome was a composite of clinical ly significant shoulder dystocia , fracture of the clavicle , brachial plexus injury , intracranial haemorrhage , or death . We did analyses by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00190320 . FINDINGS We r and omly assigned 409 women to the induction group and 413 women to the expectant management group , of whom 407 women and 411 women , respectively , were included in the final analysis . Mean birthweight  was 3831 g ( SD 324 ) in the induction group and 4118 g ( 392 ) in the expectant group . Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity ( n=8 ) compared with expectant management ( n=25 ; relative risk [ RR ] 0·32 , 95 % CI 0·15 - 0·71 ; p=0·004 ) . We recorded no brachial plexus injuries , intracranial haemorrhages , or perinatal deaths . The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group ( RR 1·14 , 95 % CI 1·01 - 1·29 ) . Caesarean delivery and neonatal morbidity did not differ significantly between the groups . INTERPRETATION Induction of labour for suspected large-for- date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management . Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery . These benefits should be balanced with the effects of early-term induction of labour . FUNDING Assistance Publique-Hôpitaux de Paris and the University of Geneva 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 R and omized clinical trials have shown that induction of labour does not result in higher caesarean delivery rates in women who are postterm . Despite this evidence , the policy of inducing women who are postterm is not generally applied in the Netherl and s. This provides us with the opportunity to assess whether the findings from r and omized studies can also be observed in nonr and omized studies and to vali date these findings in the Dutch obstetric population . We performed a retrospective matched cohort study ( 1:1 ratios for both age and parity ) in women with uncomplicated pregnancies of 42 weeks ' duration and compared induction of labour with a policy of serial antenatal monitoring .  Analyses were made by the intention to treat principle . We studied 674 women . Among the 337 women in the expectant management group , 42 ( 12.5 % ) underwent caesarean delivery , compared to 46 ( 13.6 % ) of the 337 women in the induction group ( relative risk [ RR ] , 0.9 ; 95 % confidence interval [ CI ] , 0.6 - 1.4 ) . However , the incidence of shoulder dystocia ( RR , 4.3 ; 95 % CI , 1.3 - 15 ) and meconium-stained amniotic fluid ( RR , 1.8 ; 95 % CI , 1.4 - 2.3 ) were higher in the expectant management group . Induction of labour does not result in an increased risk of caesarean delivery in women who are postterm . Because epidemiologic studies suggest an increased risk of perinatal death and birth injury beyond 42 weeks ' gestation , induction of labour should be offered to all women who are postterm Abstract Objective : To determine the risk of cesarean delivery associated with post date s induction ( ≥41 weeks ) compared to term induction ( 37–40w6d ) among women with an unfavorable cervix , and to examine the risk factors associated with cesarean among women undergoing post date s induction . Methods : A planned secondary analysis of a large prospect i ve cohort study on induction ( n = 854 ) was performed . Women with a singleton gestation , intact membranes , and an unfavorable cervix ( Bishop score of ≤6 and dilation ≤2 cm ) who were undergoing a term ( ≥37 weeks ) induction for any indication were included . Women with a prior cesarean were excluded . The primary outcome was cesarean delivery . Relative risk of cesarean was estimated using a modified Poisson ’s regression model . Results : There was a significantly increased risk of cesarean for women undergoing post date s induction ( n = 154 ) compared to women 37–40w6d ( n = 700 ) , ( 46.8 versus 26.0 % , p < .001 ) . This increased risk of cesarean remained after adjustment for race , parity , and pregnancy-related hypertension ( aRR 1.70 [ 1.39–2.09 ] , p < .001 ) . Risk factors independently associated with cesarean among women ≥41 weeks included nulliparity ( aRR 3.38 95%CI ( 2.42–4.74 ) ) , BMI ≥30 ( aRR 1.72 95%CI ( 1.34–2.21 ) ) , and starting cervical dilation < 1 cm ( aRR 1.37 95%CI ( 1.11–1.70 ) ) . Conclusions : Women ≥41 weeks undergoing an induction with an unfavorable cervix are at a significantly increased risk of cesarean compared to women 37–40w6d , with nulliparity , obesity , and cervical dilation < 1 cm being independent risk factors . These data can be used to augment patient counseling and support the ongoing discussion regarding the risk of post date s induction 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 OBJECTIVE The Disproportionate Intrauterine Growth Intervention Trial at Term ( DIGITAT trial ) showed that in women with suspected intrauterine growth restriction ( IUGR ) at term , there were no substantial outcome differences between induction of labour and expectant monitoring . The objective of the present analysis is to evaluate whether maternal or fetal markers could identify IUGR fetuses who would benefit from early labour induction . STUDY DESIGN The DIGITAT trial was a multicenter , parallel and open-label r and omised controlled trial in women who had a singleton pregnancy beyond 36 + 0 weeks ' gestation with suspected IUGR ( n=650 ) . Women had been r and omly allocated to either labour induction or expectant monitoring . The primary outcome was a composite measure of adverse neonatal outcome , defined as neonatal death before hospital discharge , Apgar score < 7 , umbilical artery pH < 7.05 , or admission to neonatal intensive care . Using logistic regression modelling , we investigated associations between outcome and 17 markers , maternal characteristics and fetal sonographic and Doppler velocimetry measurements , all collected at study entry . RESULTS 17 ( 5.3 % 
    Output:
    
Available evidence supports IOL for women with post-term pregnancy  , although the evidence is weak regarding the timing ( 41 versus 42 weeks ) , and for women with hypertension/preeclampsia in terms of improved maternal outcomes .
For women with preterm premature rupture of membranes ( 24 - 37 weeks ) , high- quality evidence supports expectant  management  rather than IOL/early birth .
Evidence is weakly supportive for  IOL  in women with term rupture of membranes .
While for some indications , IOL is clearly recommended , a number of common indications for IOL do not have strong supporting evidence .