***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 : Although repeat cesarean deliveries often are associated with serious morbidity , they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity . Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries . METHODS : Prospect i ve observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years ( 1999–2002 ) . RESULTS : There were 6,201 first ( primary ) , 15,808 second , 6,324 third , 1,452 fourth , 258 fifth , and 89 sixth or more cesarean deliveries . The risks of placenta accreta , cystotomy , bowel injury , ureteral injury , and ileus , the need for postoperative ventilation , intensive care unit admission , hysterectomy , and blood transfusion requiring 4 or more units , and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries . Placenta accreta was present in 15 ( 0.24 % ) , 49 ( 0.31 % ) , 36 ( 0.57 % ) , 31 ( 2.13 % ) , 6 ( 2.33 % ) , and 6 ( 6.74 % ) women undergoing their first , second , third , fourth , fifth , and sixth or more cesarean deliveries , respectively . Hysterectomy was required in 40 ( 0.65 % ) first , 67 ( 0.42 % ) second , 57 ( 0.90 % ) third , 35 ( 2.41 % ) fourth , 9 ( 3.49 % ) fifth , and 8 ( 8.99 % ) sixth or more cesarean deliveries . In the 723 women with previa , the risk for placenta accreta was 3 % , 11 % , 40 % , 61 % , and 67 % for first , second , third , fourth , and fifth or more repeat cesarean deliveries , respectively . CONCLUSION : Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries , the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery . LEVEL OF EVIDENCE : OBJECTIVE : To compare induction of labor at gestational age 41 weeks with expectant management in regard to neonatal morbidity . Secondary aims were to assess the effect of these managements on mode of delivery and maternal complications . METHODS : Between September 2002 and July 2004 , postterm women with singleton cephalic presentation and no prelabor rupture of membranes were r and omly assigned to induction of labor at 289 days or antenatal fetal surveillance every third day until spontaneous labor . Main outcome measures were neonatal morbidity , operative delivery rates , and maternal complications . RESULTS : Five hundred eight women were r and omly assigned , 254 in each group . No differences of clinical importance were observed in women in whom labor was induced compared with women who were expectantly managed with regard to the following outcomes : neonates whose 5-minute Apgar score was less than 7 ( three neonates in the induction group compared with four in the monitoring group , P=.72 ) ; neonates whose umbilical cord pH was less than 7 ( three compared with two , P=.69 ) ; prevalence of cesarean delivery ( 28 compared with 33 , P=.50 ) ; or prevalence of operative vaginal delivery ( 32 compared with 27 , P=.49 ) . In the induction group more women had precipitate labors ( 33 compared with 12 , P<.01 ; number needed to treat was 13 ) , and the duration of second stage of labor was more often less than 15 minutes ( 94 compared with 56 , P<.01 ; number needed to treat was 7 ) . CONCLUSION : No differences were found between the induced and monitored groups regarding neonatal morbidity or mode of delivery , and the outcomes were generally good . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00385229 LEVEL OF EVIDENCE : 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 OBJECTIVE Studies of  cesarean delivery ( CD ) rates  among women undergoing induction of labor ( IOL ) often compare such women to women experiencing spontaneous labor at similar gestational ages . We sought to examine the association between IOL at various gestational ages and CD , accounting for the effect of increased gestational age among the comparison group who were managed expectantly . STUDY DESIGN We conducted a retrospective cohort study of all term , singleton , cephalic presentation pregnancies delivered at our institution over 15 years excluding cesarean deliveries before labor . For each gestational age of induction , we created a comparison group of women who were undelivered at that gestational age , and who experienced labor at some future gestational age . RESULTS In women undergoing IOL at 38 weeks gestation , the CD rate was 11.9 % as compared to 13.3 % ( P = .42 ) of women beyond 38 weeks gestation . The CD rate for induction of labor compared to ongoing pregnancy was 14.3 % versus 15.0 % ( P = .62 ) at 39 weeks , 20.4 % versus 19.0 % ( P = .41 ) at 40 weeks , and 24.3 % versus 26.0 % ( P = .39 ) at 41 weeks . When controlling for potential confounding , there was a higher rate of CD among women with expectant management beyond 38 weeks ( adjusted odds ratio [ AOR ] 1.80 ; 95 % CI 1.29 - 2.53 ) , 39 weeks ( 1.39 ; 95 % CI 1.08 - 1.80 ) , and 40 weeks ( AOR 1.27 ; 95 % CI 1.00 - 1.62 ) . CONCLUSION Our findings suggest that IOL may not increase a woman 's  risk of CD when compared to expectant management . While this question has been addressed prospect ively at 41 weeks gestation , it requires further examination at earlier gestations and among various subgroups 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 Abstract . In a prospect i ve r and omized study spontaneous and oxytocin induced labor “ for convenience ” have been compared with respect to uterine activity , duration of labor , the condition of the fetus and the newborn infant . The study consists of 84 normal patients , of whom 43 were induced at full term by amniotomy and oxytocin infusion using the Cardiff Infusion System Mark II ; 41 patients served as controls . No difference in maternal age , number of previous pregnancies and pelvic score one week before the day of delivery were found between the groups . The following parameters were calculated : duration of labor , uterine activity , amount of bleeding in the third stage of labor , number of early and late decelerations as well as number of episodes of bradycardia in the CTG‐recordings , birth weight , Apgar score one and five minutes post‐delivery and blood gases in mother and child 60 seconds after delivery . No significant differences between the two groups were found . It is concluded that there are no increased risks to mother or fetus compared to normal labor provided that there is cephalic presentation and normal pregnancy , careful selection with respect to the length of pregnancy and the condition of the cervix and that the Cardiff infusion system is used with intrauterine pressure recording and continuous fetal heart monitoring BACKGROUND Several r and omized , controlled trials compared the policies of induction of labor and expectant management for women who reach 41 weeks ' gestation , and although they suggest a better outcome for mothers and infants with such a policy in place , controversy continues as to which is the better form of care . The Canadian Multicenter Postterm Pregnancy Trial ( CMPPT ) enrolled 3407 women , of whom 1701 were r and omized to a policy of induction of labor ( induced group ) and 1706 were r and omized to a policy of expectant management ( expectant group ) . Secondary analyses of data from the CMPPT were undertaken to explore a number of controversial issues . METHODS We used data from the CMPPT to explore further the timing of delivery for women enrolled between 41 0/7 and 41 6/7 weeks ' gestation , the potential impact of more liberal use of prostagl and ins on cesarean section rates , and the relative merits of induced versus spontaneous labor in the two groups . RESULTS Most women in the CMPPT ( 89 % ) were enrolled at 41 0/7 to 41 6/7 weeks ' gestation , of whom 86.2 percent in the induced group and 63.6 percent in the expectant group gave birth before 42 weeks ' gestation . Assuming that administration of prostagl and ins would reduce the likelihood of cesarean section by 12 to 15 percent , cesarean section rates were reduced in the induction group from 21.2 percent to 20.8 to 20.9 percent , and in the expectant group from 24.5 percent 23.3 to 24.2 percent . If labor was induced as part of a policy of expectant management , the cesarean section rate was much higher ( 33.5 % ) than if labor was either spontaneous or induced as part of a policy of induction ( 18.5 % , 22.4 % ) . CONCLUSIONS Women should be informed of the benefits and risks associated with the policies of induction of labor and expectant management , and their preferences regarding these policies should be respected The effect of induction of labor on the neonatal bilirubin levels was investigated in a prospect i ve r and omized study . Forty‐three infants born after elective induction with oxytocin using the Cardiff infusion system and 38 infants born after spontaneous delivery were studied . Several factors other than oxytocin administration which could influence the bilirubin levels such as gestational age , placental transfusion and feeding routines did not differ between the two groups . There were no differences with regard to pH in umbilical vein , Apgar scores , haemoglobin and erythrocyte volume fractions or bilirubin levels neonatally . Thus there was no evidence of an association between induction of labor with oxytocin  and jaundice during the neonatal period OBJECTIVE To compare the obstetric outcome of induction of labor at 41 weeks and of follow-up until 42 weeks and induction if the patient has still not given birth at 42 weeks . STUDY DESIGN Six hundred women at 287+/-1 days of gestation with definitely unfavorable cervical scores were r and omized to labor induction ( N=300 ) or spontaneous follow-up ( N=300 ) with twice-weekly nonstress testing and amniotic fluid measurement and once-weekly biophysical scoring . The treatments used in the induction group were ( 1 ) vaginal administration of 50 microg misoprostol ( n=100 ) , ( 2 ) oxytocin induction ( n=100 ) , and ( 3 ) transcervical insertion of a Foley balloon ( n=100 ) . The primary outcome measures were the cesarean delivery rate , whether or not the normal hospital stay had to be extended , and the neonatal outcomes . Secondary outcome measure included number of emergency cesarean deliveries performed for abnormalities of the fetal heart rate ( FHR ) . RESULTS The abdominal delivery rate was 19.3 % 
    Output:
    
R and omized , controlled trials have compared the rates of cesarean delivery between women with induction of labor and those with expectant management of pregnancy , and have generally concluded that the cesarean rate was unchanged or lower among the induced group ( 8 , 9 ) .