***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 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 A total of 85 women with antepartum fetal death between 14 and 42 weeks gestation was r and omly assigned to one of two regimens of intravenous infusion of the prostagl and in analogue 16‐phenoxy‐17 , 18 , 19 , 20‐tetranor‐PGE2‐methylsulphonamide ( sulprostone ) for inducing labour . Women received either 1 μg/min until delivery or the commonly recommended treatment of 1500 μg in 8 h followed by another , identical course of treatment if delivery did not occur within 24 h. The 1 μg/min dose schedule used half the amount of prostagl and in and result ed in statistically significantly fewer gastrointestinal side‐effects compared with the conventional treatment . All women were delivered vaginally and there were no differences in induction‐to‐delivery intervals between the two treatments  . Sulprostone infused at a rate of 1 μg/min result ed in a 50 % chance of being delivered within 12 h and a 90 % chance of being delivered within 24 h , with an overall frequency of side‐effects of 20 % Using a r and omized double-blind research design , the efficacy and safety of intravenous prostagl and in F2a ( PF ) and oxytocin ( O ) for inducing labor were compared in term pregnant women . The results show that successful induction depends upon the condition of the cervix , and for comparable groups there was no difference for PF or O. The PF failures occurred in patients who were significantly more obese .  The incidence of uterine hypertonus , hot flashes and vein phlebitis was increased significantly in the PF group but there was no difference in the incidence of fetal bradycardia , nausea , vomiting or diarrhea . The infants delivered vaginally were of similar weight and had similar 1- and 5-minute Apgar scores . Laboratory toxicity studies , before and after infusions ( complete blood count , uric acid , bilirubin , SGOT , and blood urea nitrogen ) , were similar for the two drug groups , except that hemoglobin levels postinfusion were significantly higher in the O group . The incidence of cesarean section was significantly increased in the PF group and these sections were done for uterine hypertonus and /or fetal bradycardia . Caution should be exercised before prostagl and in Fα solutions are used routinely to induce labor at term A comparison has been made between the effectiveness of infusing prostagl  and in F2a with Syntocinon for the induction of labour , in the presence of intact membranes A double blind trial of prostagl and in E2 and oxytocin given by intravenous infusion after amniotomy for induction of labour in 100 primigravidae with unfavourable induction features is reported . No clear‐cut advantage of either drug emerged although PGE2was perhaps superior when the cervix was highly unfavourable . Prostagl and in E2appeared to produce less deleterious effects on the fetus but was associated with a higher incidence of maternal side effects . The automatic Cardiff Infusion apparatus was found to be a safe means of PGE2infusion and to have advantages over the use of non‐automatic techniques both for PGE2 and for oxytocin infusion One hundred consecutive women with singleton pregnancies and primary rupture of membranes ( PROM ) after 36 weeks of gestation were included in a prospect i ve , r and omized trial of intravenous infusion of oxytocin ( up to 30 mIU/min ) versus low‐dose prostagl and in F2α(PGF2αup to 6.0 μg/min ) .  Cesarean section was performed in 12 patients because of suspected disproportion or intra‐uterine asphyxia .  Effective contractions or labor progress failed to become established within 8 hours in another 4 women stimulated with PGF2α and 2 stimulated by oxytocin .  The stimulation delivery time ( hours ) for the remaining 82 women treated with PGF2α or oxytocin , respectively was 8.7 against 12.1 for initial Bishop score < 5 ( p<0.01 ) , ( Mann‐Whitney test ) , 7.2 vs. 7.1 for Bishop score 5–8 and 5.7 vs. 4.2 for Bishop score > 8 . Patients with initial Bishop score < 5 seemed to need analgetics less often when treated with PGF2α than with oxytocin . Frequencies of side effects and instrumental deliveries as well as the fetal outcome were similar for the two treatment schedules . The results of the study suggest that low‐dose PGF2α infusion may be the more appropriate treatment for women with an unfavorable initial Bishop score A double-blind study was conducted to determine the effects of prostagl and in F2 alpha on the levels of estriol and progesterone in the peripheral venous blood during term pregnancy and to compare the effects of PGF2 alpha with that produced by oxytocin .  32 multiparous volunteers in the last 4 weeks of pregnancy were r and omly assigned to 1 of 2 groups the first group of 12 women receiving oxytocin for labor induction and the 2nd group of 20 women receiving PGF2 alpha . The subjects in both groups were of comparable age parity . and weight . 3 inductions failed in the oxytocin group compared to 8 in the PGF2 alpha group . As the process of delivery itself may alter plasma steroid levels both groups were further subdivided into those subjects who delivered and those who did not deliver . The data suggest that neither oxytocin nor PGF2 alpha given intravenously to term pregnant women for labor induction significantly altered the plasma levels of estriol or progesterone In a group of 20 matched primigravid patients labour was induced by forewater amniotomy followed by intravenous oxytocin ( Syntocinon ) administered in escalating doses . Ten of these patients , in a double-blind trial , also received prostagl and in E2 infused simultaneously with the oxytocin . In the combined prostagl and in-oxytocin group there was a noticeable reduction in the dosage of oxytocin required to produce effective uterine action , and the duration of labour was also reduced . No side effects were observed PGEM concentration was determined radioimmunologically in a non-pregnant woman in whom PGE2 was infused intravenously at increasing dosage and in women in whom labour was induced by various methods for local application of PGE2 .  There was excellent correlation between the amount of PGE2 infused intravenously and the levels of PGEM determined in the peripheral plasma . The following methods of local application of PGE2 were included in the study : 0.4 mg PGE2 gel placed retroamnially by means of a balloon catheter ; 0.4 and 0.5 mg PGE2 gel applied endocervically ; 1.5 mg PGE2 given pericervically through a portio adapter and 3 mg PGE2 placed intravaginally in form of a single vaginal tablet ; also included was a control group where only vaginal examination was performed . Blood was withdrawn before , and then 30 minutes , 1 , 2 and 3 hours after PGE2 administration . Mean levels of PGEM in the maternal peripheral plasma showed no change within or between the various groups , with the exception of one patient in the portio adapter group where hyperstimulation occurred . After removal of the adapter PGEM levels dropped to baseline values . It is concluded from the present study that local application of doses currently used to soften the cervix and /or induce labour at term does not give rise to PGEM concentrations in the maternal blood of the same magnitude as achieved by intravenous PGE2 administration A comparison has been made between the effectiveness of infusing prostagl and in E2 with Syntocinon for the induction of labour in the presence of intact membranes . Rapid titration schedules were used to induce an early uterine response . All 15 subjects receiving prostagl and in E2 achieved cervical dilatation , whereas this occurred in only 9 out of 15 patients receiving Syntocinon Abstract Prostagl and ins E 2 and F 2 α and synthetic oxytocin were studied for efficacy and side effects in a double-blind protocol for the induction of labor at term in 100 women . That an inducibility scoring index should be part of each clinical oxytocin trial is evidence d by the fact that erroneous conclusions would have been drawn if it had not been used . All patients who were classified as having " easy inductions " were delivered independent of which drug they received ; however , the 3 categories of grade d " difficult inductions " reflected success rates from 93.3 to 40 per cent , depending upon difficulty of induction . Synthetic oxytocin and prostagl and in F 2 α were found to be equally efficacious in the difficult groups although more cases will be required to allow significant statistical analysis . Except for an increased incidence of innocuous uterine hypertonus , no significant side effects of prostagl and in infusions were noted A double-blind trial of oxytocin ( Syntocinon ) and prostagl and in E2 ( PGE2 ) in the induction of labor in 300 patients result ed in equally high success rates for both drugs . 73 % of the patients in each group were delivered or achieved a 6 cm dilatation of the cervix within 12 hours of the start of infusion . The patients were not matched for factors known to affect labor and thus no statistical analysis of the results was attempted . In the successful cases there were no maternal complications of treatment . ( authors 
    Output:
    
REVIEW ER 'S CONCLUSIONS Intravenous prostagl and in is no more efficient than intravenous oxytocin for the induction of labour but its use is associated with higher rates of maternal side effects and uterine hyperstimulation than oxytocin .
No conclusions can be drawn form the comparisons of combination of prostagl and in F2 alpha and oxytocin compared to oxytocin alone or extra amniotic and intravenous prostagl and in E2