***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 
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    Input: One hundred thirty-four indigent patients at term who had premature rupture of membranes and a cervix unfavorable for induction of labor ( 80 % effacement or less , 2 cm dilation or less ) were r and omized to compare  expectant with intervention management .  Women with any medical or obstetric condition warranting immediate intervention were excluded from the study . Patients treated expectantly were placed at bed rest and observed for labor or infection . Patients managed by intervention were given oxytocin if labor did not ensue within 12 hours of rupture of the membranes . Patients in the intervention protocol had longer labor ( P<.02 ) and a higher incidence of both cesarean delivery ( P<.05 ) and intraamniotic infection ( P<.05 ) . There was only one case of proven neonatal sepsis , and this occurred in a patient managed by induction of labor . There was no statistically significant difference between groups in mean length of maternal hospitalization Summary : We performed a prospect i ve r and omized study to compare maternal and fetal outcomes in pregnancies with prelabour rupture of the membranes ( PROM ) at term with early induction of labour or expectant management , 126 women with singleton pregnancy , cephalic presentation and gestational duration > 37 weeks , were r and omized either to immediate induction of labour with oxytocin ( Group 1 ) ( n= 52 ) , or conservative management ( Group 2 ) ( n=74 ) . Women who constituted Group 2 were divided into 2 groups . The first group ( Group 2A ) ( n=25 ) included women in whom spontaneous labour did not begin after a waiting period of 24 hours , in which case labour was induced with oxytocin i.e. expectant management . The second group consisted of women ( Group 2B ) ( n=49 ) in whom labour began spontaneously within 24 hours . The base Caesarean section rate was significantly higher in Group 2 ( 28.4 % ) ( p<0.05 ) . The rates of Caesarean section in the Groups 1–2A‐2B were 19.2 % , 60 % , and 12.2 % , respectively for nulliparous and parous women together . The rate of fetal distress was significantly higher in Group 2 ( p<0.05 ) . For determining maternal outcomes , the other parameters such as clinical chorioamnionitis , fever before or during labour , receiving antibiotics before or during labour , postpartum fever , analgesia , anaesthesia did not differ in Groups 1 and 2 . Women in Group 1 went into active labour sooner , had fewer digital vaginal examinations , had a shorter interval between membrane rapture and delivery , and spent less time in the hospital before delivery than those in Group 2 ( p<0.05 ) . Babies in Group 2 were more likely to receive  antibiotics  , and more likely to stay in an intensive care nursery for more than 24 hours , and more likely to receive ventilation after initial resuscitation than those babies in Group 1 . For developing apnoea and hypotonia , there was no significant difference between Groups 1 and 2 . However , for babies in Group 2A there was a significant difference . We conclude that immediate induction of labour with oxytocin does not increase the risk of Caesarean section , compared with a practice of expectant management . Women at term with prelabour rupture of the membranes should therefore be reassured that immediate induction with oxytocin currently appears to be the best policy with respect to maternal and neonatal morbidity BACKGROUND Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection , but immediate delivery is associated with risks of prematurity . The balance of risks is unclear . We aim ed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity . METHODS The PPROMT trial was a multicentre r and omised controlled trial done at 65 centres across 11 countries . Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included . Women were r and omly assigned ( 1:1 ) by a computer-generated r and omisation schedule with variable block sizes , stratified by centre , to immediate delivery or expectant management . The primary outcome was the incidence of neonatal sepsis . Secondary infant outcomes included a composite neonatal morbidity and mortality indicator ( ie , sepsis , mechanical ventilation ≥24 h , stillbirth , or neonatal death ) ; respiratory distress syndrome ; any mechanical ventilation ; and duration of stay in a neonatal intensive or special care unit . Secondary maternal outcomes included antepartum or intrapartum haemorrhage , intrapartum fever , postpartum treatment with antibiotics , and mode of delivery . Women and caregivers could not be masked , but those adjudicating on the primary outcome were masked to group allocation . Analyses were by intention to treat . This trial is registered with the International Clinical Trials Registry , number IS RCT N44485060 . FINDINGS Between May 28 , 2004 , and June 30 , 2013 , 1839 women were recruited and r and omly assigned : 924 to the immediate birth group and 915 to the expectant management group . One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses . Neonatal sepsis occurred in 23 ( 2 % ) of 923 neonates whose mothers were assigned to immediate birth and 29 ( 3 % ) of 912 neonates of mothers assigned to expectant management ( relative risk [ RR ] 0·8 , 95 % CI 0·5 - 1·3 ; p=0·37 ) . The composite secondary outcome of neonatal morbidity and mortality occurred in 73 ( 8 % ) of 923 neonates of mothers assigned to immediate delivery and 61 ( 7 % ) of 911 neonates of mothers assigned to expectant management ( RR 1·2 , 95 % CI 0·9 - 1·6 ; p=0·32 ) . However , neonates born to mothers in the immediate delivery group had increased rates of respiratory distress ( 76 [ 8 % ] of 919 vs 47 [ 5 % ] of 910 , RR 1·6 , 95 % CI 1·1 - 2·30 ; p=0·008 ) and any mechanical ventilation ( 114 [ 12 % ] of 923 vs 83 [ 9 % ] of 912 , RR 1·4 , 95 % CI 1·0 - 1·8 ; p=0·02 ) and spent more time in intensive care ( median 4·0 days [ IQR 0·0 - 10·0 ] vs 2·0 days [ 0·0 - 7·0 ] ; p<0·0001 ) compared with neonates born to mothers in the expectant management group . Compared with women assigned to the immediate delivery group , those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage ( RR 0·6 , 95 % CI 0·4 - 0·9 ) , intrapartum fever ( 0·4 , 0·2 - 0·9 ) , and use of postpartum antibiotics ( 0·8 , 0·7 - 1·0 ) , and longer hospital stay ( p<0·0001 ) , but a lower risk of caesarean delivery ( RR 1·4 , 95 % CI 1·2 - 1·7 ) . INTERPRETATION In the absence of overt signs of infection or fetal compromise , a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term . FUNDING Australian National Health and Medical Research Council , the Women 's and Children 's Hospital Foundation , and The University of Sydney Premature rupture of the membranes ( PROM ) in otherwise uncomplicated full-term single pregnancies was studied in a prospect i ve r and omized study . Ninety-three women were r and omized to either  induction with oxytocin infusion ( n = 43 ) or expectant management ( n = 50 ) . Twenty-four and 26 respectively were nulliparas . In the induction group , all but 3 were delivered within 24 h from PROM . There were 3 vacuum extraction s ( VE ) , all in nulliparous women . No  cesarean section ( CS ) was performed . In the expectancy group , 23 of 50 were delivered within 24 h. There were 5 VE and 3 CS in nulliparas and 1 VE and 1 CS in paras . The instrumental actions were mainly due to arrest of 1st or 2nd stage labor . The only clinical infections occurred in nulliparas in the expectancy group . Our conclusion is that parous women with PROM can be treated by either induction or expectancy while in nulliparas , induction after some hours ' expectation seems preferable Objective : To determine whether delayed induction of labor in patients with premature rupture of membranes ( PROM ) at term has beneficial effects on the mother or the infant . Study Design : Retrospective analysis of our data base revealed 576 patients > 37 weeks of gestation with PROM , who delivered live-born infants without major congenital anomalies . We analyzed the frequencies of  primary cesarean , neonatal intensive care unit ( NICU ) admissions  , and  oxytocin use by time since hospital admission and interval until onset of labor . Results : NICU admission increased from 1.9 % in <3 h between admission to onset of labor to 13.3 % after > 18 h. Admission-onset of labor interval , birth weight of < 2,500 or > 4,000 g and meconium were all more important determinants of NICU admission than gestational age , duration of labor , PROM , and ROM . Prolonged admission-onset of labor interval was associated with an increased risk of variable decelerations ( p < 0.001 ) . Primary cesarean rates increased progressively with longer intervals between admission and onset of labor . Stepwise discriminant function analysis revealed that labor duration , admission-onset of labor interval , gestational age , and birth weight of < 2,500 g were all more important determinants of primary cesarean delivery than the duration s of PROM or ROM . Conclusions : The increased frequencies of NICU admission , variable decelerations , and primary cesarean suggest that delayed labor induction after hospital admission was linked to worsened perinatal outcomes . These results may have been influenced by usually performing a single digital examination as part of initial evaluation of term patients who present with PROM . Based on our data , we suggest immediate induction for PROM at term , especially if digital examination has been performed One hundred and thirty-five healthy primigravid women at or near term with spontaneous rupture of the membranes without uterine contractions were su bmi tted to a prospect i ve trial of management . Rupture of the membranes was diagnosed by speculum examination . If labor did not commence , induction was performed by oxytocin infusion starting at 9 AM following admission . One hundred and five women went into labor spontaneously before induction became necessary . Sixty-three of these women required augmentation with oxytocin . Twenty-seven percent of the induced group required cesarean section delivery compared to 10 % of those in spontaneous labor augmented by oxytocin and to none of those who did not require oxytocin ( p less than 0.01 ) . Ninety-four percent of those in spontaneous labor were delivered vaginally compared to 73 % of the induced group ( p less than 0.01 ) . Forty-one percent of the augmented group were delivered by forceps . Awaiting the spontaneous onset of labor for 24 hours or less did not result in clinical maternal or neonatal infection . We would therefore advocate awaiting the spontaneous onset of labor after spontaneous rupture of membranes without contractions at or near term in healthy primigravid women for up to 24 hours because it seems to confer significant advantages without producing any additional hazard BACKGROUND As the interval between rupture of the fetal membranes at term and delivery increases , so may the risk of fetal and maternal infection . It is not known whether inducing labor will reduce this risk or whether one method of induction is better then another . METHODS We studied 5041 women with prelabor rupture of the membranes at term . The women were r and omly assigned to induction of labor with intravenous oxytocin ; induction of labor with vaginal prostagl and in E2 gel ; or expectant management for up to four days , with labor induced with either intravenous oxytocin or vaginal prostagl and in E2 gel if complications developed . The primary outcome was neonatal infection . Secondary outcomes were the need for cesarean section and women 's evaluations of their treatment . RESULTS The rates of neonatal infection and cesarean section were not significantly different among the study groups . The rates of neonatal infection were 2.0 percent for the induction-with-oxytocin group , 3.0 percent for the induction-with-prostagl and in group , 2.8 percent for the expectant-management ( oxytocin ) group , and 2.7 percent for the expectant-management ( prostagl and in ) group . The rates of cesarean section ranged from 9.6 to 10.9 percent . Clinical chorioamnionitis was less likely to develop in the women in the induction-with-oxytocin group than in those in the expectant-management ( oxytocin ) group ( 4.0 percent vs. 8.6 percent , P<0.001 ) , as was postpartum fever ( 1 
    Output:
    
In subgroup analyses , there were no clear patterns of differential effects for method of induction , parity , use of maternal antibiotic prophylaxis , or digital vaginal examination .
There is low quality evidence to suggest that planned early birth ( with induction methods such as oxytocin or prostagl and ins ) reduces the risk of maternal infectious morbidity compared with expectant management for PROM at 37 weeks ' gestation or later , without an apparent increased risk of caesarean section .