***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 compare intracervical prostagl and in E2 gel and membrane sweeping for cervical ripening . STUDY DESIGN Fifty patients were r and omized to either intracervical prostagl and in E2 or membrane sweeping . A Bishop score was assigned by a blinded examiner prior to and 24 hours following the procedure . RESULTS The Bishop scores assigned 24 hours after prostagl and in instillation and membrane sweeping were not significantly different ( 3.4 , SE 0.42 , vs. 3.3 , SE 0.37 , respectively ; P > .05 ) . The proportions of women entering active labor or delivering within 24 hours were similar in the prostagl and in and membrane groups ( 21 % and 19 % , respectively ; P > .05 ) . CONCLUSION When both intracervical prostagl and in insertion and membrane sweeping are feasible , their salutary effects are comparable Objective To determine whether cervical membrane sweeping ( stripping ) during induction of labor is beneficial . Methods We compared outcomes of labor after induction in pregnant women at term in a r and omized trial . Women were assigned to having their membranes swept or not during induction . Outcome measures included duration of labor , maximum dose of oxytocin used , induction-labor interval , and mode of delivery . Results We recruited 130 nulliparas ( 64 sweep , 66 non-sweep ) and 118 multiparas ( 60 sweep , 58 nonsweep ) . Among nulliparas who received intravaginal prostagl and in ( PG ) E2 and oxytocin , those who had simultaneous sweeping had significantly shorter mean ( ± st and ard error of mean ) induction-labor interval ( 13.6 ± 1.4 versus 17.3 ± 1.2 hours , P = .048 ) , lower mean maximum dose of oxytocin ( 6.8 ± 0.8 versus 10.35 ± 1.1 mU/minute , P = .01 ) , and increased normal delivery rates ( vaginal delivery 83.3 % versus 58.2 % , P = .01 ) . Sweeping also had a favorable effect on nulliparas who received oxytocin alone ( mean induction-labor interval 5.8 ± 3.1 versus 11.2 ± 3.6 hours , P = .04 ; mean maximum dose 8.8 ± 1.3 versus 16.3 ± 1.9 mU/min , P = .01 ) . Those differences were limited to women with unfavorable cervices . There were no differences in any outcome measures in multiparous women . Conclusion Sweeping of the membranes during induction of labor had a beneficial effect on labor and delivery , which appeared to be limited to nulliparas with unfavorable cervices who needed cervical priming with PGE2 OBJECTIVES To assess the efficacy of stripping of membranes in initiation of labor and to study its effect on maternal and perinatal morbidity . METHOD One-hundred primigravidae with certain gestational date s were r and omized at 38 weeks gestation to either receive stripping of membranes or only gentle cervical examination . Cervical swabs were taken before pelvic examination at 38 weeks and again at the onset of labor . Placental membranes were sent for bacteriological study after delivery in all patients . RESULTS The mean gestational age , parity and Bishop score were similar in both groups at recruitment . Gestational age at delivery was lower in the study group ( 38.70 + /- 0.63 ) compared to the control group . Seventy-two percent of the study group and 8 % of the control group had spontaneous onset of labor within 7 days of examination . Labor was induced in one patient ( 2 % ) of the study group and 16 patients ( 32 % ) of the control group . No statistically significant difference was noted in incidence of premature rupture of membranes ( PROM ) , mode of delivery , intrapartum events and perinatal outcome . No increase in neonatal morbidity was seen in association with this procedure . No patient in the study group had clinical evidence of chorioamnionitis . There was no statistically significant difference in the microbiological flora of both groups . CONCLUSION Stripping of the fetal membranes is a safe and efficacious procedure for induction of labor . It decreases the incidence of induction of labor with no increase in incidence of maternal and neonatal morbidity Objecfive To determine the proper management of pregnancy  in uncomplicated cases going beyond 42 weeks Objective To assess the efficacy of sweeping of membranes beyond 40 weeks of gestation in reducing the incidence of induction of labour , when induction was planned at 42 weeks OBJECTIVE To determine whether routine antepartum stretching of the cervix and stripping of the membranes at term would shorten the length of pregnancies , and whether this correlated with cervical status and fetal and maternal parameters . DESIGN A prospect i ve , r and omised , controlled study of 293 term gravidas , free of medical complications , divided into two groups : stretching/stripping , and non-stretching/stripping . Digital separation of the fetal membranes from the lower uterine segment , and cervical stretching , were performed during routine vaginal examination of the first group . In the second group , only routine vaginal examination was performed . RESULTS Of 293 patients , 152 underwent a trial of stretching and stripping ; 141 served as a control group . The mean interval ( hours to delivery after the procedure ) was 136 h ( S.D. 10 ) , compared to 161 h ( S.D. 11 ) in the control group ( P = 0.095 ; not significant ) , but with only a trend towards the shorter interval in the first group . When patients were matched according to weeks of gestation and fetal and maternal parameters , only those at 41 weeks ' gestation or more had a significant reduction in the interval from the procedure to delivery ( mean 91 h ( S.D. 8) compared to mean 125 h ( S.D. 10 ) in the control group ; P < 0.007 ) . This observation was independent of cervical status and other maternal or fetal parameters . CONCLUSIONS Only patients > or = 41 weeks ' gestation benefitted from  stretching of the cervix  and  stripping  of the fetal membranes . The effect was not dependent on the cervical status or other maternal and fetal parameters Concentrations of 13,14-dihydro-15-keto-PGF2 alpha ( PGFM ) were measured in plasma of six carefully selected primigravid women with an unripe cervix at term before and at various intervals after extra-amniotic insertion of a Foley catheter with or without methylhydroxyethylcellulose ( Tylose ) gel .  The procedure caused an acute elevation of PGFM levels within 5 min ( P less than 0.025 ) , which was maintained for at least 6 hours in the absence of uterine activation at 179 + /- 32 % of the initial values ( P less than 0.01 ) . Extra-amniotic administration of Tylose gel caused an increase in PGFM levels which was both higher and more prolonged ( greater than 12 hours ) than insertion of a Foley catheter alone . The observations indicate that cervical ripening without concomitant uterine activation is associated with an increase in PGFM levels . They also demonstrate that prolonged activation of ( intra ) uterine prostagl and in synthesis may occur several hours before the onset of labor-like uterine activity . A chance finding further suggests that spontaneous rupture of the membranes too may be preceeded by an increase in ( intra ) uterine prostagl and in synthesis . In their totality these observations lend strong support to the proposition that an increase in ( intra ) uterine prostagl and in production is a prerequisite to rather than a consequence of the initiation of labor OBJECTIVE Our purpose was to determine whether the risk for postdatism can be reduced by serial membrane sweeping in women with an unfavorable cervix at 39 weeks ' gestation and a negative fetal fibronectin test result . STUDY DESIGN Women with uncomplicated pregnancies , who were c and i date s for a vaginal delivery with an unfavorable cervix at 39 weeks ' gestation and a negative fetal fibronectin test result were asked to participate in this investigation . Patients were chosen at r and om and assigned to a group for membrane sweeping every 3 days or to a control group who received gentle examinations every 3 days . RESULTS Sixty-five women were selected at r and om for serial membrane sweeping ( n = 33 ) or for the control group ( n = 32 ) . Although gestational age and Bishop score at study entry were similar , the gestational age on admission for delivery was earlier in the membrane sweeping group ( 39.9 + /- 0.3 ) versus the control group ( 41.5 + /- 0.6 , P < .0001 ) . The Bishop score on admission to labor and delivery was greater ( 8.8 + /- 2.1 ) in the membrane sweeping group than in the control group ( 6.2 + /- 2.7 , P < .0001 ) . The number of women admitted for labor inductions at 42 weeks ' gestation was 18 of 32 ( 56 % ) in the control group versus none ( 0 of 24 ) in the membrane-sweeping group ( P < .0001 ) . CONCLUSIONS Women with an unfavorable cervix at 39 weeks ' gestation and a negative fetal fibronectin test result are at risk for not being delivered by 41 completed weeks and thus may require post date s induction or antenatal testing . Serial membrane sweeping significantly reduces the risk of postdatism and induction of labor The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies . We r and omly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days . Our patients were divided into three groups . Group A consisted of 34 women who were subjected to sweeping of the membranes . Uterine stimulation with oxytocin was applied in 35 women ( group B ) , and 35 women ( group C ) were used as a control group . We had no significant reduction of the time interval from sweeping of the membranes until delivery ( 1.9 ± 1.2 days ) , compared to that of group B ( 2.1 ± 0.8 days ) as well as that of the control group ( 2.5 ± 0.9 days ) . The incidence of spontaneous labor in patients after sweeping of the membranes was greater ( 67.6 % ) when compared with oxytocin-stimulated patients and the control group ( p < 0.05 ) . Furthermore , a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups , but sweeping of the membranes significantly decreased the incidence of postterm pregnancies ( p < 0.05 ) . We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks , thus reducing the need for induction OBJECTIVE Our purpose was to determine the optimal management of pregnancies beyond 41 weeks ' gestation with a cervix unfavorable for induction . STUDY DESIGN All uncomplicated pregnancies that reached 41 weeks ' gestation with a Bishop score of < or = 4 were r and omly assigned to one of three groups : ( 1 ) daily cervical examinations , ( 2 ) daily membrane stripping , or ( 3 ) daily placement of prostagl and in gel until 42 weeks . RESULTS In 105 pregnancies the Bishop score on admission to labor and delivery  was significantly greater in the groups receiving prostagl and in or stripping of the membranes versus the control group , whereas the converse was time of gestational age at delivery ( p = 0.0001 ) . Fewer patients required induction in the two treatment groups ( 20 % , 17 % ) versus the control ( 69 % ) patients ( p < 0.0001 ) . CONCLUSIONS Daily membrane stripping or daily placement of prostagl and in gel is successful in reducing the number of inductions at 42 weeks for postdatism Objective To determine whether sweeping the membranes in pregnancies of longer than 40 weeks gestation results in an accelerated onset of labour and a reduction in the incidence of induction of labour OBJECTIVE Our purpose was to determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment ( membrane stripping ) are involved in observed clinical changes compared with patients not so treated . STUDY DESIGN Thirty patients were r and omly divided among a study population and two control groups to assess uterine contractions and microbiologic , histologic , and biochemical markers associated with parturitional events over a 7-hour time frame . RESULTS Clinical ly , an increased frequency of uterine contractile activity was observed among patients in the membrane-stripped group ( p < 0.03 ) . There was a significant increase in plasma 13,14-dihydro-15-keto-prostagl and in F2 alpha ( p < 0.001 ) and endocervical phospholipase A2 activity ( p < 0.04 ) among those who underwent membrane stripping .  Blood leukocyte counts , sedimentation rates , prostagl and in E2 metabolite concentrations , and fibronectin levels revealed no significant change during the 7-hour study session . CONCLUSION Membrane stripping was associated with increases in phospholipase A2 activity and prostagl and in F2 alpha concentrations , indicating a possible correlation with initiation of the cascade of parturitional events O 
    Output:
    
Discomfort during vaginal examination and other adverse effects ( bleeding , irregular contractions ) were more frequently reported by women allocated to sweeping .
REVIEW ER 'S CONCLUSIONS Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinical ly important benefits .