***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: The effect of prostagl and in E2 ( PGE2 ) in ' ripening ' the cervix was studied in 33 patients who required surgical induction of labour . Patients included primigravidas and parous subjects between 36 and 42 weeks of gestation . Sixteen patients received a total oral dose of 5 mg PGE2 and 17 received 4 - 6 mg PGE2 intravaginally in the form of a gel . There was significant improvement in ' ripeness ' of the cervix in all groups , the intravaginal route giving slightly better results than the oral route . Ten patients remained unsuitable for induction because of inadequate dilatation of the cervix or a high fetal head . Four patients on oral therapy developed late decelerations of the fetal heart and 3 of these were delivered by immediate caesarean section . The implication s of this and the reasons for the inability to perform inductions after ' ripening ' are discussed 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 Abstract . The efficacy of oral PGE2 tablets and buccal demoxytocin ( resoriblets ) for the induction of labor in cases of premature rupture of the membranes ( PROM ) after the 37th week of gestation has been evaluated in a prospect i ve , r and omized investigation of 193 women .  PGE2 tablets ( Pro‐stinR ) were given to 109 parturients and demoxytocin resoriblets ( S and opartR ) to 84 . The former were given in increasing doses from an initial 0.5 mg to a maximum of 1.5 mg every hour . The demoxytocin was administered at a constant dosage of 50 I.U. every 30 min The use of prostagl and in E2 for the induction of labor with intact membranes is described and its effectiveness is compared to intravenous syntocinon .  40 primigravida and 60 multigravid patients with previous medical and obstetrical histories were studied . The patients were numbered as they entered the trial , with the odd numbers in each group being given oral prostagl and in and the even numbers intravenous syntocinon . In no case was the pregnancy less than 38 weeks maturity . No patient was in labor prior to being given either drug . Prostagl and in E2 ( PGE2 ) was supplied in ampoules containing 5 milligrams in 0.5 milliliter of ethanol . This was added to 49.5 milliliters of sterile water to produce a concentration of the drug of 0.1 milligrams per ml . The syntocinon infusion was prepared by putting 20 units of syntocinon into 1 liter of 5 % dextrose in water to produce a solution concentration of 20 mu/ml . The accepted criteria for diagnosing established labor for both groups of patients was the presence of uterine contractions occurring once every 3 minutes , associated with progressive dilatation of the cervix . For both groups of patients it was decided that cervical dilatation should be at least 6 cm within 18 hours of the infusion starting . Using this criterion there was only 1 failure , occurring in the 1st primigravid patient given PGE2 , the labor in this instance being completed with intravenous syntocinon . A further 8 patients failed to complete the trial as they had to be delivered by cesarian section . Syntocin was considerably more efficient than PGE2 in inducing labor in the remaining 91 patients particularly in primigravida . This was the case whether judged by the length of labor or by the induction delivery interval . Toco-dynamometric studies showed that the contractions produced by prostagl and in more closely resembled those of normal labor and were less painful Labor was induced for medical reasons at or near term in altogether 200 patients . The women were r and omly assigned to low amniotomy and either oral PGE2 or intravenous infusion of oxytocin . The initial PGE2 dose was 0.5 mg , followed by 1.0 mg every hour for up to 24 hours . Oxytocin was given as an intravenous pump infusion , starting with 5 mIU/min and rising stepwise to 20 mIU/min . Uterine contractility and fetal heart rate ( FHR ) were recorded by cardiotocography in 61 women receiving oxytocin and in 63 given prostagl and in E2 . A detailed analysis of the contractility pattern was performed in 16 women , eight from each group In a prospect i ve study of  neonatal jaundice 739 infants , delivered vaginally , in the vertex presentation , and without major complications , were examined . Labour was induced or stimulated after r and om allocation of the mothers to one of three oxytocics ( prostagl and in E2 orally , oxytocin intravenously , or demoxytocin buccally ) . Oxytocics were unnecessary after primary amniotomy in 91 women . A linear logistic statistical analysis showed that gestational age has a highly significant influence on the risk of jaundice ( defined by maximum serum level of bilirubin greater than or equal to 205 mumol/l ) . An apparent influence of birthweight could be explained by the correlation between birthweight and gestational age . The influence of the three oxytocic agents was not significant , although they may have had a slight effect ; however , any such effect could be a consequence of the infants of mothers given oxytocics being less mature than those whom mothers did not receive oxytocics . The duration of labour and the mother 's age also had no effect on risk of jaundice . Thus , neonatal jaundice after induced and stimulated labour seems to be primarily associated with fetal maturity ; the pharmacological side-effect , if any , of oxytocics is of no importance The induction of labour with prostagl and in E2 ( PGE2 ) tablets in two dosage regimens , and with desamino-oxy-tocin , has been studied in association with amniotomy . In multiparas at or near term and with a high Bishop score .  PGE2 appears superior with regard to the induction-to-delivery interval and the duration of labour , but both preparations are highly effective in this respect . In nulliparas with a low Bishop score  , however , intravenous oxytocin  after amniotomy is the method of choice A double blind study was undertaken to determine the effectiveness or oral prostagl and in E2 as a means of improving the pelvic score prior to induction of labour . 48 patients who were greater than 37 weeks gestation and who had Bishop scores of less than 6 entered the study . Ten tablets were given on an hourly regime . Of 25 patients in the prostagl and in group , 17 were considered successes ( 68.0 % ) , whereas of 23 patients who received a placebo , 9 were successes ( 39.1 % ) . No adverse effects were recorded . Prostagl and in E2 is therefore considered a safe and effective method for priming the unfavourable cervix prior to induction of labour We report the results of a pilot study conducted to compare the efficacy of oral prostagl and in E2 versus intravenous oxytocin in inducing labour after lower amniotomy in 20 primigravid patients at term . The results suggest no significant differences in the performance of each group for the induction to delivery interval , the mode of delivery , the Apgar score at five minutes or for third stage abnormalities . However , the use of oral PGE2 allows the patient unrestricted mobility and avoids the discomfort of i.v . infusions Sixty‐nine patients ( 48 primigravidae and 21 multigravidae ) with 12 hours of spontaneous premature rupture of membranes ( PROM ) after 36 weeks gestation were r and omly allocated to receive either prostagl and in E2 ( PGE2 ) oral tablets or intravenous oxytocin to stimulate labor Prostagl and in E2-tablets were compared to intravenous oxytocin for the stimulation of labor in 201 patients at or near term , with premature spontaneous rupture of the membranes without labor activity for 6 hours after the escape of fluid . The patients were r and omly allocated ; 99 were treated with PGE2-tablets ( 0.5 - 1.5 mg/hr ) and 102 with intravenous oxytocin ( 7.5 - 45 mIU/min ) . The treatment was ineffective in the PGE2 group in 3 cases ; these were treated successfully with intravenous oxytocin . In the oxytocin group , 3 patients were delivered by cesarean section for reasons not associated with the drug . A significant difference was found in the stimulation-delivery time , in favor of intravenous oxytocin . Although PGE2 tablets are a safe and convenient alternative to intravenous oxytocin , the investigation showed that intravenous oxytocin is preferable in cases of premature rupture of the membranes with more than 6 hours without labor activity Abstract . Oral prostagl and in in hourly doses of 0.5 mg PGE2 was given to 58 patients with an initial Bishop score of five or less , for two 12‐hour periods in order to prime the cervix . After priming , the patients were induced with oral PGE2 ; 90 % of these patients were delivered . In a control group comprising 59 patients induced with  oxytocin  , the delivery rate was only 51 % Summary A prospect i ve survey was carried out on 187 parous patients , in whom labour was induced by amniotomy and either intravenous oxytocin or oral prostagl and in E2 , (PGE2).The  results show no significant difference in the performance of each group for the induction to delivery interval , the mode of delivery , the Apgar score at 5 minutes or for third stage anomalies . The use of oral PGE2offers advantages to the patient who is spared the discomfort , restriction and minor risks associated with an intravenous infusion ; and to the midwife who does not have to make frequent checks on the flow rate if an infusion pump is not available . The method also permits the ancillary equipment , which may well be in limited supply , to be reserved for more ‘ at risk ’ cases Fifty pregnant women at term , with a cervix unfavorable for induction , were electively induced with intravenous oxytocin after priming with either oral prostagl and in E2 or a placebo . Oral PGE2 was effective in increasing the Bishop score and in inducing labor prior to the induction , but did not increase the incidence of successful inductions A clinical trial involving 60 patients was conducted to assess the relative efficacy of intravenous oxytocin and oral prostagl and in E2 in ripening the unfavourable cervix , when given as a priming dose on the day before induction of labour . There was significant improvement in the Bishop score , and the subsequent induction‐delivery interval  following priming with prostagl and in . This improvement appeared to be dose‐related 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 In 100 clinical ly-normal women , labor was induced at term by low amniotomy and PGE2 . The drug was administered by either the oral or the oromucosal route , the same incremental dose scheme ( initial dose of 0.5 mg ; hourly increment of 0.5 m 
    Output:
    
Otherwise , there were no significant differences between groups for this outcome .
Oral prostagl and in was associated with vomiting across all comparison groups .
REVIEW ER 'S CONCLUSIONS Oral prostagl and in consistently result ed in more frequent gastrointestinal side effects , in particular vomiting , compared with the other treatments included in this review .
There were no clear advantages to oral prostagl and in over other methods of induction of labour