***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: This study attempted to determine the best method of treatment for patients with recurrent preterm labor : administration of terbutaline via an automated , programmable , subcutaneous infusion pump or oral terbutaline . In this retrospective , controlled study , 32 patients diagnosed with recurrent preterm labor , as determined by persistent uterine contractions with cervical change , were treated with a programmable infusion pump adjusted to control uterine contraction frequency to < or = 4 contractions per hour . Patients in this group were matched for age , race , parity , gestational age and cervical dilation at diagnosis of recurrent preterm labor in subjects taking oral terbutaline .  The patients receiving oral terbutaline were given an average of 6.5 mg every four to six hours to maintain uterine quiescence , while those in the pump group were given basal rates of terbutaline and in addition received four to six boluses per day ( < 3 mg/d total dose ) to achieve this outcome . Patients using the pump were more likely to reach term and less likely to fail tocolytic therapy than were those taking oral terbutaline . The terbutaline pump appeared to be more successful in prolonging pregnancies to term after the diagnosis of recurrent preterm labor than did oral terbutaline PURPOSE To compare the clinical benefit and cost-effectiveness of utilizing continuous subcutaneous terbutaline versus oral tocolytics following recurrent preterm labor . DESIGN Retrospective , 1:1 matched cohort . METHODOLOGY From prospect ively collected data in a nationwide , perinatal data base of women receiving outpatient services , we identified singleton gestations having recurrent preterm labor , stabilized during hospitalization , and subsequently treated with oral tocolytics ( PO group ) or continuous subcutaneous terbutaline infusion ( SQ group ) . Those without medically indicated delivery were eligible for inclusion . Each woman in the PO group was matched 1:1 by gestational age at recurrent preterm labor to a woman in the SQ group . A st and ardized cost model was applied to compare total antepartum hospital , nursery , and outpatient charges . Wilcoxon Signed Rank , paired t , and McNemar 's C2 test statistics were used for comparisons . PRINCIPAL FINDINGS 558 women were studied ( 279 per group ) . The PO group had less gestational gain following recurrent preterm labor than the SQ group ( 28.4 + /- 19.8 days vs. 33.9 + /- 19.0 days , respectively , P < .001 ) . The SQ group had less per patient charges ( $ ) for antepartum hospitalization ( 3,986 + /- 6,895 vs. 5,495 + /- 7,131 , P = .009 ) , and nursery ( 7,143 + /- 20,048 vs. 15,050 + /- 32,648 , P < .001 ) . Outpatient charges were less for the PO group ( 1,390 + /- 1,152 vs. 5,520 + /- 3,292 , P < .001 ) . Overall costs for those in the SQ group were $ 5,286 less per pregnancy compared to the PO group . CONCLUSION In this population , continuous subcutaneous terbutaline infusion was both a clinical ly beneficial and cost-effective treatment following recurrent preterm labor OBJECTIVE Our hypothesis was that use of the subcutaneous terbutaline pump does not affect  maternal glucose tolerance . STUDY DESIGN With the 1-hour glucose tolerance test , we examined the incidence of  glucose intolerance in 37 patients using the pump compared with that of 54 patients receiving oral terbutaline and 634 control subjects without risk factors for gestational diabetes . The frequency of gestational diabetes and the need for insulin to maintain glycemic control were subjected to chi 2 analysis . RESULTS The incidence of gestational diabetes was 6 % in the control subjects , 5 % in patients using the pump ( p = 0.8 ) , and 11 % in those on the oral therapy regimen ( p = 0.4 ) . A total of 8 % of controls who had gestational diabetes required both insulin and diet , compared with 100 % using the pump ( p less than 0.01 ) and 50 % on the oral terbutaline regimen ( p = 0.03 ) . CONCLUSION The incidence of gestational diabetes is not increased in patients receiving terbutaline via the subcutaneous pump . The use of terbutaline by any route significantly increases the need for insulin to achieve glycemic control To determine the efficacy of the terbutaline pump for the prevention of preterm delivery , patients in preterm labor defined by progressive cervical change underwent intravenous magnesium sulfate tocolysis  ( with or without oral indomethacin , as necessary ) , and once labor was arrested , were r and omized to one of three treatment arms : terbutaline by pump , saline by pump ( blinded ) , or oral terbutaline . If recurrent preterm labor occurred despite maximization of therapy , the treatment arm was determined and therapy was changed ; saline pump and oral terbutaline were switched to terbutaline pump , terbutaline pump was switched to oral terbutaline . Patients who continued to labor were readmitted for aggressive intravenous therapy . Women r and omized to the terbutaline pump ( n = 15 ) , saline pump  ( n = 12 ) , and oral terbutaline  ( n = 15 ) groups were similar in terms of gravidity , parity , days of tocolysis before study entry , gestational age at entry , and cervical dilatation at entry . The mean gestational age at delivery was the same in all three groups ( 35 weeks ) , as were neonatal outcomes . Terbutaline by pump , saline by pump , and oral terbutaline appear equivalent for the prevention of preterm delivery . The terbutaline pump should remain experimental We examined pregnancy outcomes in women receiving nifedipine tocolysis having recurrent preterm labor ( RPTL ) . Singleton gestations enrolled for outpatient nursing surveillance and prescribed nifedipine tocolysis were identified ( N = 4748 ) . Women hospitalized for RPTL at < 35 weeks then resuming outpatient surveillance were included ( N = 1366 ) . Pregnancy outcomes of women resuming nifedipine ( N = 830 ) were compared with those having an alteration in treatment to continuous subcutaneous terbutaline ( N = 536 ) . Overall , 56.7 % ( 2692/4748 ) experienced RPTL . Half ( 50.7 % ) were stabilized and resumed outpatient surveillance with nifedipine or continuous subcutaneous terbutaline . Infants from women resuming nifedipine versus those with alteration of treatment to terbutaline were more likely to deliver at < 35 weeks ( 28.0 % versus 13.8 % ) , weigh < 2500 g ( 32.9 % versus 20.3 % ) , and require a stay in the neonatal intensive care unit ( 34.0 % versus 23.1 % ) , all P < 0.001 . Alteration of tocolytic treatment following RPTL result ed in a decreased incidence of preterm birth and low birth weight , result ing in less admission to the neonatal intensive care unit and fewer nursery days 
    Output:
    
The authors conclude that subcutaneous terbutaline pump is beneficial and safe for maintenance of tocolysis based on all the available evidence .
Although we found that the pump was beneficial for some outcomes ( i.e. , neonatal death , incidence of delivery < 32 weeks and < 37 weeks , and prolonging pregnancy ) , importantly , these benefits were rated as having low strength of evidence , which means that we have low confidence that the evidence reflects the true effect [ 22 ] .