***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: 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 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 In a prospect i ve r and omized study , pregnancies with unfavorable cervix and well established gestational age of at least 42 weeks were selected for management by either antepartum fetal testing or prostagl and in gel induction of labor . Of the 108 pregnancies studied , 57 ( 53 % ) had labor induced and 51 ( 47 % ) continued without intervention . Comparison of the two groups showed no difference in meconium staining , fetal distress , length of first stage of labor , the need for intervention , or the mode of delivery . In terms of Apgar score the neonatal outcome was not significantly different but a greater proportion of the babies ( 7.8 % versus 1.8 % ) in the noninduced group required intubation . Our data show that there is no particular advantage in letting the pregnancy go beyond 42 completed weeks of gestation especially if prostagl and in is available for induction of labor OBJECTIVE To study the cesarean rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix . STUDY DESIGN A total of 249 women with uncomplicated pregnancies at 41 weeks plus 3 days ( 290 days ) with favorable cervix ( Bishop score > or = 6 ) were r and omized to either expectant management ( n=125 ) or immediate induction of labor ( n=124 ) . The women in the induction group were sent to labor ward for induction by artificial rupture of membranes ( ARM ) and /or oxytocin infusion . The women with expectant management had nonstress test ( NST ) and amniotic fluid index ( AFI ) performed once a week and twice a week after 43 weeks of gestation until spontaneous labor . RESULTS The cesarean rate was not different between expectant management and immediate induction ( 21.6 % versus 26.6 % ; P=0.36 ) . Ninety-five percent of the expectant group delivered within 1 week after enrollment , and all of them delivered within 9 days after r and omization . Maternal and fetal complications in both groups were not different . There was also no difference in the mean birth weight ( P=0.24 ) and the frequency of macrosomia ( birth weight > or = 4000 g ) between the two groups ( P=0.23 ) . CONCLUSION Cesarean section rate between expectant management and immediate induction in the otherwise uncomplicated postterm pregnancy with favorable cervix was not different . Due to the very low adverse perinatal outcome , both expectant management and immediate induction are acceptable BACKGROUND The two methods of management of prolonged pregnancy , induction of labour and expectant management with foetal surveillance , have pros and cons . Therefore , we compared the induction of labour with serial antenatal foetal monitoring in the management of post-term pregnancy . METHODS Seventy-four women with uncomplicated pregnancy at 41 weeks ( 287 days ) of gestation were r and omly assigned to undergo either induction of labour or serial antenatal foetal monitoring . Labour was induced in the latter group whenever there was evidence of foetal compromise . Antenatal monitoring consisted of the foetal kick count , non-stress test and biophysical profile . RESULTS Fifty-seven per cent of women went into spontaneous labour by 41 weeks and 4 days ( 291 days ) of gestation and only 14 % developed foetal compromise before that . However , when the gestational age was more than 41 weeks and 4 days ( 291 days ) , the incidence of meconium staining of amniotic fluid and evidence of uteroplacental insufficiency increased significantly . The rate of caesarean section , instrumental delivery , foetal distress and duration of labour did not differ significantly between the two groups . CONCLUSION The policy of inducing labour at 41 weeks and 4 days ( 291 days of gestation ) in uncomplicated pregnancies is justified in our population . However , foetal monitoring should begin at 41 weeks of gestation Objective . In view of the increased risk of obstetric and perinatal complications in post‐term pregnancy , and the lack of consensus regarding clinical routines for fetal surveillance and labor induction , the aim of this prospect i ve controlled study was to compare obstetric and perinatal outcome after serial monitoring until 43 weeks of gestation with that after labor induction at 42 gestational weeks In a prospect i ve , r and omised trial , 111 obstetrically normal pregnant women , who had elective induction of labour performed between 39 and 40 weeks , were compared with 117 controls who were managed expectantly until 41 weeks . Compared with the controls , the patients who had elective induction of labour had significantly less meconium staining in labour and a smaller blood-loss after delivery . The mean length of labour , the amount of pethidine used , and the Apgar scores at 1 minute were similar in the two groups . In the electively induced group , the caesarean-section rate was lower and the use of epidural analgesia more common than in the controls , but the differences were mot statistically signficant . The hour of delivery was similar in the two groups , suggesting that convenience to medical and nursing staff would not be greatly changed by elective induction of labour . There was no evidence that the hazards to mother and child were increased by elective induction , and its use might improve perinatal mortality by reducing the number of unexplained mature stillbirths OBJECTIVE To determine maternal and perinatal morbidity and the spontaneous labor rate beyond 41 weeks of gestation . METHOD Patients with uncomplicated pregnancy were recruited at 41 weeks and screened for fetal or maternal well-being . Following observation between 41 and 42 weeks , patients were r and omized to either serial monitoring by cardiotocography and measurement of amniotic fluid index , or to immediate induction . Comparisons were made using the chi(2 ) test . Results after 42 weeks were analyzed according to intention at r and omization . RESULTS Morbidity was not increased before 42 weeks . After 42 weeks , the cesarean section rate and incidence of meconium below the vocal cords were increased in monitored patients . The median gestational age in patients who were monitored was 298.5 ( 294 - 321 ) days . In patients observed from 41 weeks , 91.6 % labored spontaneously . CONCLUSION It is reasonable to observe uncomplicated pregnancy until 42 weeks with adequate monitoring . After 42 weeks , induction of labor is preferred A r and omized prospect i ve clinical trial of induction of labor  at 42 completed weeks gestation versus expectant management in post date s pregnancies was performed . The primary screening test was the 24-hr urinary estriol creatinine ratio . The cesarean section rate was high in both groups and did not differ statistically . Intervention by delivery at 42 weeks decreased the development of small for gestational age infants , but costs slightly more . Twenty-four-hour urinary estriol creatinine ratio determinations predicted fetal distress in labor , but could not predict postmaturity syndrome or infants who were small for gestational age . As expectant management did not differ from induction of labor at 42 weeks from the st and point of maternal outcome , and as the cost difference was small , induction of labor at 42 weeks may be the preferred management as it improves infant outcome Three hundred two low-risk obstetric patients with an unfavorable cervical examination and well-established gestational age of at least 287 days were r and omly selected for management by either antepartum fetal testing or prostagl and in gel cervical ripening followed by aggressive induction of labor and delivery . The patients managed by induction of labor had a lower incidence of meconium-stained amniotic fluid , meconium aspiration , low Apgar scores , postmaturity syndrome , fetal distress , and cesarean delivery than did patients managed with antepartum fetal testing . Our data suggest that prostagl and in gel  cervical ripening and induction of labor and delivery by 42 weeks ' gestation may be the most appropriate management for patients with well-established gestational age and an unfavorable cervical examination A non-aggressive approach to the management of post- date pregnancies was tested in a clinical trial involving 156 patients who had reached 294 days of amenorrhea and had a pelvic score of 4 or less . Date s had been established with certainty in each case . In half of the patients ( the study group ) no time limit was imposed on the pregnancy , but the women were checked at frequent intervals for any increase in pelvic score and for changes in any of the following : fetal movement count recorded daily by the mother , an  oxytocin challenge test  , and  amnioscopy .  The pregnancy ended either through spontaneous contractions or through surgical induction carried out because of a change in any one of the parameters or an increase above 4 in the pelvic score . In the 78 control patients labor was induced surgically on day 294 , even if the pelvic score was low . In the study group , labor started spontaneously in 52 patients ; labor was induced in 17 women after they showed an elevated pelvic score , in 7 because of a pathologic parameter and in one because a mild pre-eclampsia developed . There were 7 cesarean sections in the study group compared with 16 in the control group ( P less than 0.05 ) . The average duration of labor was 6.7 h in the study group , compared with 9.4 h in the control ( P less than 0.01 ) . There was no significant difference between the two groups with regard to meconium staining during labor , pathologic fetal heart rate , or the 5 min Apgar score . In the study group there was one neonatal death as a result of severe congenital heart disease , and in the control group one infant died due to asphyxia . It is concluded that conservative management of prolonged pregnancies , with close supervision , gives better results than routine induction of labor at 42 wk . The importance of the pelvic score as an indication for induction is stressed . A protocol has been developed which can be used in cases of uncertain date s as well The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development Post date pregnancy is estimated to occur in 3 % to 12 % of all gestations . Morbidity and mortality rates associated with this common obstetric problem are higher than those with term gestation . The incidence of fetal distress , birth injury , meconium aspiration , congenital malformations , macrosomia , and oligohydramnios is also greater in post date pregnancy . We prospect ively evaluated breast self-stimulation to determine its effect on the incidence of post date pregnancy .  Two hundred low-risk patients at 39 weeks ' gestation were r and omly assigned to either a control group or a breast-stimulation group . Results showed that breast stimulation reduced the number of pregnancies managed as post date s from 17 per 100 ( 17 % ) to five per 100 ( 5 % ) ( p less than 0.01 ) , a 70 % reduction . It is concluded that breast stimulation in post date s pregnancies can decrease significantly the number of patients that must be monitored by biochemical or biophysical means In a prospect i ve r and omised study of mothers referred for prolonged pregnancy ( around the 42nd week ) 214 ( group 1 ) were su bmi tted to attempted induction of labour  and 195 ( group 2 ) assigned to continue for a further week without intervention . Strict selection criteria were used for the certainty of term . Mothers in group 2 were given regular non-stress tests to ensure fetal wellbeing , as were those in group 1 in whom induction failed . In group 1 , 48 ( 23 % ) out of 210 first attempted inductions failed . In group 2 , 135 ( 69 % ) of the births started spontaneously as compared with 38 ( 18 % ) in group 1 . The mean duration of labour was 7.5 hours in each group . There was no significant difference in incidence of operative delivery , use of analgesics , or signs of per 
    Output:
    
CONCLUSION A policy of labor induction at 41 weeks ' gestation for otherwise uncomplicated singleton pregnancies reduces cesarean delivery rates without compromising perinatal outcomes