***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 Pregnancies complicated by intrauterine growth retardation ( IUGR ) beyond 36 weeks of gestation are at increased risk of neonatal morbidity and mortality . Optimal treatment in IUGR at term is highly debated . Results from the multicenter DIGITAT ( Disproportionate Intrauterine Growth Intervention Trial At Term ) trial show that induction of labor and expectant monitoring result in equal neonatal and maternal outcomes for comparable cesarean section rates . We report the maternal health-related quality of life ( HR-QoL ) that was measured alongside the trial at several points in time . Methods Both r and omized and non-r and omized women were asked to participate in the HR-QoL study .  Women were asked to fill out written vali date d question naires , covering background characteristics , condition-specific issues and the Short Form ( SF-36 ) , European Quality of Life ( EuroQoL 6D3L ) , Hospital Anxiety and Depression scale ( HADS ) , and Symptom Check List ( SCL-90 ) at baseline , 6 weeks postpartum and 6 months postpartum . We compared the difference scores of all summary measures between the two management strategies by ANOVA . A repeated measures multivariate mixed model was defined to assess the effect of the management strategies on the physical ( PCS ) and mental ( MCS ) components of the SF-36 . Analysis was by intention to treat . Results We analyzed data of 361 r and omized and 198 non-r and omized patients . There were no clinical ly relevant differences between the treatments at 6 weeks or 6 months postpartum on any summary measures ; e.g. , on the SF-36 ( PCS : P = .09 ; MCS : P = .48 ) . The PCS and the MCS were below norm values at inclusion . The PCS improved over time but stayed below norm values at 6 months , while the MCS did not improve . Conclusion In pregnancies complicated by IUGR beyond 36 weeks , induction of labor does not affect the long-term maternal quality of life Background Around 80 % of intrauterine growth restricted ( IUGR ) infants are born at term . They have an increase in perinatal mortality and morbidity including behavioral problems , minor developmental delay and spastic cerebral palsy . Management is controversial , in particular the decision whether to induce labour or await spontaneous delivery with strict fetal and maternal surveillance . We propose a r and omised trial to compare effectiveness , costs and maternal quality of life for induction of labour versus expectant management in women with a suspected IUGR fetus at term . Methods / design The proposed trial is a multi-centre r and omised study in pregnant women who are suspected on clinical grounds of having an IUGR child at a gestational age between 36 + 0 and 41 + 0 weeks . After informed consent women will be r and omly allocated to either induction of labour or expectant management with maternal and fetal monitoring . R and omisation will be web-based . The primary outcome measure will be a composite neonatal morbidity and mortality . Secondary outcomes will be severe maternal morbidity , maternal quality of life and costs . Moreover , we aim to assess neurodevelopmental and neurobehavioral outcome at two years as assessed by a postal enquiry ( Child Behavioral Check List-CBCL and Ages and Stages Question naire-ASQ ) . Analysis will be by intention to treat . Quality of life analysis and a preference study will also be performed in the same study population . Health technology assessment with an economic analysis is part of this so called Digitat trial ( Disproportionate Intrauterine Growth Intervention Trial At Term ) . The study aims to include 325 patients per arm . Discussion This trial will provide evidence for which strategy is superior in terms of neonatal and maternal morbidity and mortality , costs and maternal quality of life aspects . This will be the first r and omised trial for IUGR at term . Trial registration Dutch Trial Register and IS RCT N-Register : IS RCT N10363217 OBJECTIVE To test whether steroids reduce respiratory distress in babies born by elective caesarean section at term . DESIGN Multicentre pragmatic r and omised trial . SETTING 10 maternity units . PARTICIPANTS 998 consenting women r and omised at decision to deliver by elective caesarean section ; 503 r and omised to treatment group . INTERVENTIONS The treatment group received two intramuscular doses of 12 mg betamethasone in the 48 hours before delivery . The control group received treatment as usual . OUTCOME MEASURES The primary outcome was admission to special care baby unit with respiratory distress . Secondary outcomes were severity of respiratory distress and level of care in response . RESULTS Sex , birth weight , and gestation were not different between the two groups . Of the 35 babies admitted to special baby units with respiratory distress , 24 were in the control group and 11 in the intervention group ( P = 0.02 ) . The incidence of admission with respiratory distress was 0.051 in the control group and 0.024 in the treatment group ( relative risk 0.46 , 95 % confidence interval 0.23 to 0.93 ) . The incidence of transient tachypnoea of the newborn was 0.040 in the control group and 0.021 in the treatment group ( 0.54 , 0.26 to 1.12 ) . The incidence of respiratory distress syndrome was 0.011 in the control group and 0.002 in the treatment group ( 0.21 , 0.03 to 1.32 ) . CONCLUSIONS Antenatal betamethasone and delaying delivery until 39 weeks both reduce admissions to special care baby units with respiratory distress after elective caesarean section at term OBJECTIVE The Disproportionate Intrauterine Growth Intervention Trial at Term ( DIGITAT trial ) showed that in women with suspected intrauterine growth restriction ( IUGR ) at term , there were no substantial outcome differences between induction of labour and expectant monitoring . The objective of the present analysis is to evaluate whether maternal or fetal markers could identify IUGR fetuses who would benefit from early labour induction . STUDY DESIGN The DIGITAT trial was a multicenter , parallel and open-label r and omised controlled trial in women who had a singleton pregnancy beyond 36 + 0 weeks ' gestation with suspected IUGR ( n=650 ) . Women had been r and omly allocated to either labour induction or expectant monitoring . The primary outcome was a composite measure of adverse neonatal outcome , defined as neonatal death before hospital discharge , Apgar score < 7 , umbilical artery pH < 7.05 , or admission to neonatal intensive care . Using logistic regression modelling , we investigated associations between outcome and 17 markers , maternal characteristics and fetal sonographic and Doppler velocimetry measurements , all collected at study entry . RESULTS 17 ( 5.3 % ) infants in the induction group had an adverse neonatal outcome compared to 20 ( 6.1 % ) in the expectant monitoring group . The only potentially informative marker for inducing labour was maternal pre-pregnancy body mass index ( BMI ) . Otherwise , we observed at best weak associations between a benefit from labour induction and maternal age , ethnicity , smoking , parity , pregnancy-induced hypertension or preeclampsia , Bishop score and gestational age , or fetal sonographic markers ( gender , estimated fetal weight , body measurements , oligohydramnios , or umbilical artery pulsatility index and end diastolic flow ) . CONCLUSION In late preterm and term pregnancies complicated by suspected intrauterine growth restriction , most of the known prognostic markers seem unlikely to be helpful in identifying women who could benefit from labour induction , except for maternal pre-pregnancy BMI Objective To compare the effect of induction of labour with a policy of expectant monitoring for intrauterine growth restriction near term . Design Multicentre r and omised equivalence trial ( the Disproportionate Intrauterine Growth Intervention Trial At Term ( DIGITAT ) ) . Setting Eight academic and 44 non-academic hospitals in the Netherl and s between November 2004 and November 2008 . Participants Pregnant women who had a singleton pregnancy beyond 36 + 0 weeks ’ gestation with suspected intrauterine growth restriction . Interventions Induction of labour or expectant monitoring . Main outcome measures The primary outcome was a composite measure of adverse neonatal outcome , defined as death before hospital discharge , five minute Apgar score of less than 7 , umbilical artery pH of less than 7.05 , or admission to the intensive care unit . Operative delivery ( vaginal instrumental delivery or caesarean section ) was a secondary outcome . Analysis was by intention to treat , with confidence intervals calculated for the differences in percentages or means . Results 321 pregnant women were r and omly allocated to induction and 329 to expectant monitoring . Induction group infants were delivered 10 days earlier ( mean difference −9.9 days , 95 % CI −11.3 to −8.6 ) and weighed 130 g less ( mean difference −130 g , 95 % CI −188 g to −71 g ) than babies in the expectant monitoring group . A total of 17 ( 5.3 % ) infants in the induction group experienced the composite adverse neonatal outcome , compared with 20 ( 6.1 % ) in the expectant monitoring group ( difference −0.8 % , 95 % CI −4.3 % to 3.2 % ) . Caesarean sections were performed on 45 ( 14.0 % ) mothers in the induction group and 45 ( 13.7 % ) in the expectant monitoring group ( difference 0.3 % , 95 % CI −5.0 % to 5.6 % ) . Conclusions In women with suspected intrauterine growth restriction at term , we found no important differences in adverse outcomes between induction of labour and expectant monitoring . Patients who are keen on non-intervention can safely choose expectant management with intensive maternal and fetal monitoring ; however , it is rational to choose induction to prevent possible neonatal morbidity and stillbirth . Trial registration International St and ard R and omised Controlled Trial number IS RCT N10363217 Objectives : In low-risk pregnancies , the management of oligohydramnios is not clear . The aim of this study was to compare maternal and neonatal outcomes in cases of isolated oligohydramnios r and omised to either induction of labour or expectant management . Methods : 87 women pregnant beyond 40 completed weeks were asked to participate in the study . Fifty-four accepted and were r and omised at 288 days of pregnancy . Twenty-six were r and omised to expectant management and 28 to induction of labour . The primary maternal outcome was the mode of delivery and the primary neonatal outcomes were cord blood pH and Apgar score at delivery . Results : No significant differences were found for any important maternal or neonatal outcome . Conclusion : Based on these results , the decisions about management could be individualised . Even though the number of patients included was small , these results are well in concordance with others The association between a reduction in fetal movements ( RFM ) and stillbirth has been noted for at least 450 years . This was formalised from the 1970s onwards in a series of studies that noted the increased incidence of stillbirth and FGR in women presenting with RFM , which in some cases preceded intrauterine fetal death by several days . Interpretation of the literature relating RFM to stillbirth and FGR is complicated by differences in studies ’ definitions of RFM and FGR [ 1 ] . Nevertheless , the association between RFM and stillbirth remains , irrespective of the definitions used . Recently , the Auckl and Stillbirth Study confirmed that women who had a RFM were 2.4 times ( 95 % CI 1.29 - 4.35 ) more likely to have a late stillbirth [ 2 ] , which is strikingly similar to a UK-based study which found a 3-fold increase in stillbirth after one presentation with RFM [ 3 ] . RFM , FGR and stillbirth are thought to be related by placental insufficiency , with RFM representing fetal compensation to restriction of nutrients and oxygen in utero [ 4,5 ] . This hypothesis is supported by evidence of abnormal placental structure and amino acid transport in women with RFM , even in the absence of a small-for-gestational age fetus [ 6 ] . Despite the association between RFM and stillbirth , RFM is frequently suboptimally managed clinical ly . Of 422 stillbirths review ed in a confidential enquiry , 16.4 % of cases had suboptimal care related to RFM , including : not communicating the importance of RFM to mothers and a failure to act on RFM [ 7 ] . Reasons for clinicians ’ behaviour have been explored by two related question naire studies , one in the UK and one in Australia and New Zeal and . Both of these studies found significant variations in the definitions of RFM applied to clinical practice and varied knowledge of the association between RFM , FGR and stillbirth . As a consequence clinical management of women with RFM varied significantly , with cardiotocography being used in 80 - 90 % of cases and ultrasound assessment of fetal growth , liquor volume and umbilical artery Doppler in approximately 20 % of cases [ 8,9 ] . Due to the association between RFM , FGR and stillbirth , ultrasound assessment of fetal growth , liquor volume and umbilical artery Doppler may be useful screening tests to identify placental insufficiency [ 10 ] . Norwegian studies have suggested that asking women to be more aware of fetal movements did not increase the number of attendances with RFM . Importantly , the implementation of an associated quality -improvement programme was associated with increased use of ultrasound , but a reduction of stillbirth from 4.2 % to 2.4 % [ 11 ] , strongly suggesting that appropriate identification of , and intervention following , R 
    Output:
    
AUTHORS ' CONCLUSIONS A policy for planned early delivery versus expectant management for a suspected compromised fetus at term does not demonstrate any differences in major outcomes of perinatal mortality , significant neonatal or maternal morbidity or neurodevelopmental disability .
There was also a significant difference in the proportion of babies with a birthweight centile < 2.3rd , however this did not translate into a reduction in morbidity .