human
***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 This study was design ed to determine the effectiveness of acupuncture for the initiation of labour in women at term . METHODS A prospect i ve pilot r and omized control trial was undertaken , in which 16 pregnant women at term were r and omly assigned to receive acupuncture either at sites reported to cause onset of labour or at nearby sham sites . The primary outcome assessed was the interval from initial acupuncture treatment to delivery . RESULTS There was a difference in intervention to delivery interval of 62 hours in favour of the treatment group . Furthermore , women in this group had shorter labours by a mean of 2 hours and 20 minutes . CONCLUSION The interesting results of this pilot trial warrant further investigation into the use of acupuncture for the initiation of labour in women at term OBJECTIVE to gain insight into the experiences of women , partners and midwives who participated in the Complementary Therapies for Labour and Birth Study , an evidence based complementary medicine ( CM ) antenatal education course . DESIGN qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study . SETTING AND PARTICIPANTS thirteen low risk primiparous women and seven partners who had participated in the study group of a r and omised controlled trial of the complementary therapies for labour and birth study , and 12 midwives caring for these women . The trial was conducted at two public hospitals , and through the Western Sydney University in Sydney , Australia . INTERVENTIONS the Complementary Therapies for Labour and Birth ( CTLB ) protocol , based on the She Births ® course and the Acupressure for labour and birth protocol , incorporated six evidence -based complementary medicine ( CM ) techniques ; acupressure , relaxation , visualisation , breathing , massage , yoga techniques and incorporated facilitated partner support . R and omisation to the trial occurred at 24 - 36 weeks ' gestation , and participants attended a two-day antenatal education programme , plus st and ard care , or st and ard care alone . FINDINGS the overarching theme identified in the qualitative data was making sense of labour and birth . Women used information about normal birth physiology from the course to make sense of labour , and to utilise the CM techniques to support normal birth and reduce interventions in labour . Women 's , partners ' and midwives ' experience of the course and its use during birth gave rise to supporting themes such as : working for normal ; having a toolkit ; and finding what works . KEY CONCLUSIONS the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to underst and the physiology of normal labour and birth and enabled them to use evidence -based CM tools to support birth and reduce interventions . IMPLICATION S FOR PRACTICE the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women , partners and midwives . It appears to be an effective form of antenatal education that supports normal birth , and maternity services need to consider how they can reform current antenatal education in line with this evidence Objective . To evaluate the efficacy of acupuncture for labor stimulation . Methods . Nulliparous women at 38 weeks or greater were r and omized to traditional Chinese medicine ( TCM ) acupuncture , sham acupuncture , or usual care only groups . Acupuncture points LI4 , SP6 , BL32 , and BL54 were needled bilaterally . The primary outcome was time from enrollment to delivery . Secondary outcomes included rates of spontaneous labor and cesarean delivery . Medical records were abstract ed for maternal demographic , medical , and delivery outcome data . ANOVA , Student 's t-test , Chi-square , and Kaplan – Meier statistics were used to compare groups . Results . Eighty-nine women were enrolled and r and omized . Maternal age , gestational age , prior acupuncture experience , tobacco , alcohol and drug use , gravida , and history of gynecological surgery were similar among the groups . There were no statistically significant differences among groups for time from enrollment to delivery ( p = 0.20 ) , rates of spontaneous labor ( p = 0.66 ) , or rates of cesarean delivery ( p = 0.37 ) . Rates of maternal and neonatal outcomes were not significantly different . Conclusion . TCM acupuncture was not effective in initiating spontaneous labor or reducing the rate of cesarean delivery compared with sham acupuncture or usual medical care Please cite this paper as : Modlock J , Nielsen B , Uldbjerg N. Acupuncture for the induction of labour :  a double‐blind r and omised controlled study . BJOG 2010;117:1255–1261 Abstract Aims : To evaluate the efficacy of acupuncture , and sweeping of the fetal membranes , as methods for induction of labor . Methods : Four hundred and seven pregnant women with normal singleton pregnancies and cephalic presentations were r and omized at three delivery wards in Denmark at day 290 of gestation into groups of acupuncture , sweeping , acupuncture and sweeping and controls . The primary objective was to compare the proportion of women going into labor before induction of labor at 294 days in the four groups . The secondary objective was to compare the combined groups : with and without acupuncture , and with and without sweeping of the fetal membranes . The midwives , completing the forms for the trial at labor or induction , were blinded to group assessment s. Results : Four hundred and seventeen women were r and omized . Ten were excluded after r and omization . One hundred and four women were r and omized to acupuncture , 103 to sweeping of the membranes , 100 to both acupuncture and sweeping , and 100 were r and omized to the control group . Comparison of the four groups demonstrated no significant difference in the number of women achieving spontaneous labor before planned induction . No difference was demonstrated by comparing the combined groups treated with acupuncture with the groups not treated with acupuncture ( P=0.76 ) . However , significantly more women went into labor before planned induction ( P=0.02 ) in the combined groups receiving sweeping , compared with the groups not treated with sweeping . Conclusions : Acupuncture at 41 + weeks of gestation did not reduce the need for induction . The study was of a sufficient size to demonstrate , in parallel , that sweeping of the fetal membranes significantly reduced the need of induction , sparing about 15 % for formal induction of labor Objective To measure the serum levels of interleukin (IL)-8 , prostagl and in ( PG ) F2α and β-endorphin in parturients with acupuncture treatment and in controls to clarify the effect of acupuncture and duration of labor on the serum levels of substances active in cervical ripening and dilatation . Methods A matched pair study was performed involving 80 women with and without prenatal acupuncture treatment , matched for age and parity . Serum levels of IL-8 , PGF2α , and β-endorphin were measured in serum sample s taken after delivery by use of enzyme-linked immunosorbent assay , enzyme immunoassay , and immunoradiometric assay , respectively . Results The mean difference in total duration of labor between matched pairs with and without acupuncture was-136.5 minutes ( 95 % confidence interval [ CI ] 191.1 minutes,-81.9 minutes ; paired t test , P < .001 ) . The mean difference of the duration of the first and second stages of labor between matched pairs with and without acupuncture was-138.8 minutes ( 95 % CI 188.6,-89.0 minutes ; paired t test , P < .001 ) and 2.3 minutes ( 95 % CI 15.5 , 20.1 minutes ; paired t test , P = 55 .8 ) , respectively . The geometric means of ratios of IL-8 , PGF2α , and β-endorphin between matched pairs in women with and without acupuncture showed no statistically significant differences . Serum levels of IL-8 , PGF2α , and β-endorphin were not significantly correlated with the duration of the first and second stages of labor . Conclusion Prenatal acupuncture treatment significantly reduces the duration of labor and may be a valuable tool in prenatal preparation . Serum levels of IL-8 , PGF2α and β-endorphin are not significantly influenced by acupuncture and are therefore not likely to mediate acupuncture-related effects during labor Purpose The present study was aim ed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score < 7 and to observe the characteristics of labor in both methods . Methods As much as 67 pregnant women with Bishop score < 7 , single cephalic presentation with gestational age confirmed by first-trimester ultrasound , reactive cardiotocography , and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected . They were r and omized into 2 groups : electroacupuncture ( AC ) or misoprostol ( M ) . Results There were no significant differences regarding age , gestational age , fetal weight , parity , Bishop score , or indication for induction . Labor was the main outcome , which was obtained in both groups without significant difference regarding frequency ( p = 0.07 ) and time of induction ( p = 0.29 ) . Absence of obstetric complication , higher duration of labor ( p = 0.036 ) , and tendency to a higher satisfaction of the patients ( p = 0.046 ) were observed among patients of group AC . Higher frequency of cesarean sections ( p = 0.014 ) and obstetric complications ( 9.3 % ) were observed among patients of group M. Conclusions Our results showed that electroacupuncture can be used to obtain cervical ripening , with similar results as compared with misoprostol , with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications Background : Cervical ripening is one of the main stages of initiation labor . Acupressure in Chinese medicine is considered as an invasive technique , which through reliving oxytocin ripens the cervix . Acupoint Sanyinjiao ( SP6 ) was selected in this study because it is the acupoint selected in gynecology and it is easy for women to locate and apply pressure without medical assistance . Objectives : The aim of this study was to determine the effect of acupressure on cervical ripening . Patients and Methods : In this r and omized clinical trial , 150 primigravida with term pregnancy who had referred to Deziani hospital in Gorgan were chosen and divided to three groups : in the first group acupressure was done by the research er while in the second groups this was performed by the mother her self , and the third group served as a control and only received routine care . For both intervention groups the pressure was applied on Sp6 for about 20 minutes during one to five days . Elements were checked from cervical ripening at 48 and 96 hours after intervention and at the time of hospitalization . The tools for gathering information included demographic characteristics and midwifery history question naire , daily records and follow up forms . Content validity was used for validity of tools . Reliability of the observation check-list and physical examination was confirmed by inter-rater scores ( inter observer ) , and daily records by test-re-test . Data was analyzed by analysis of variance ( ANOVA ) , Kruskal-Wallis and Chi-squared tests ( P ≤ 0.05 ) . Results : There was a significant difference between mothers ’ educations in the three groups . Most of the mothers ( 59.5 % ) in the research er-performed acupressure group had secondary education . Cervical ripening was significantly different between the three groups after 48 hours ( P ≤ 0.05 ) , yet there was no significant difference after 96 hours and at the time of admission . Mean Bishop score was enhanced after 48 hours in the research er-performed acupressure group ( P ≤ 0.021 ) and the self-performed acupressure group ( P ≤ 0.007 ) in comparison to the control group . Conclusions : The results showed that acupressure is a safe technique and leads to cervical ripening . Thus , regarding the desired results that were achieved when mothers applied acupressure themselves , it could be suggested that it is beneficial for mothers to be trained to apply this method at home Please cite this paper as : MacKenzie I , Xu J , Cusick C , Midwinter‐Morten H , Meacher H , Mollison J , Brock M. Acupuncture for pain relief during induced labour in nulliparae : a r and omised controlled study . BJOG 2011;118:440–447 Objective To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use . Design Open-label , assessor blind , r and omised controlled trial . Setting 2 public hospitals in Sydney , Australia . Population 176 nulliparous women with low-risk pregnancies , attending hospital-based antenatal clinics . Methods and intervention The Complementary Therapies for Labour and Birth protocol , based on the She Births and acupressure for labour and birth courses , incorporated 6 evidence -based complementary medicine techniques : acupressure , visualisation and relaxation , breathing , massage , yoga techniques , and facilitated partner support . R and omisation occurred at 24–36 weeks ’ gestation , and participants attended a 2-day antenatal education programme plus st and ard care , or st and ard care alone . Main outcome measures Rate of analgesic epidural use . Secondary : onset of labour , augmentation , mode of birth , newborn outcomes . Results There was a significant difference in epidural use between the 2 groups : study group ( 23.9 % ) st and ard care ( 68.7 % ; risk ratio ( RR ) 0.37 ( 95 % CI 0.25 to 0.55 ) , p≤0.001 ) . The study group participants reported a reduced rate of augmentation ( RR=0.54 ( 95 % CI 0.38 to 0.77 ) , p< 
    Output:
    
agent
***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 This study was design ed to determine the effectiveness of acupuncture for the initiation of labour in women at term . METHODS A prospect i ve pilot r and omized control trial was undertaken , in which 16 pregnant women at term were r and omly assigned to receive acupuncture either at sites reported to cause onset of labour or at nearby sham sites . The primary outcome assessed was the interval from initial acupuncture treatment to delivery . RESULTS There was a difference in intervention to delivery interval of 62 hours in favour of the treatment group . Furthermore , women in this group had shorter labours by a mean of 2 hours and 20 minutes . CONCLUSION The interesting results of this pilot trial warrant further investigation into the use of acupuncture for the initiation of labour in women at term OBJECTIVE to gain insight into the experiences of women , partners and midwives who participated in the Complementary Therapies for Labour and Birth Study , an evidence based complementary medicine ( CM ) antenatal education course . DESIGN qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study . SETTING AND PARTICIPANTS thirteen low risk primiparous women and seven partners who had participated in the study group of a r and omised controlled trial of the complementary therapies for labour and birth study , and 12 midwives caring for these women . The trial was conducted at two public hospitals , and through the Western Sydney University in Sydney , Australia . INTERVENTIONS the Complementary Therapies for Labour and Birth ( CTLB ) protocol , based on the She Births ® course and the Acupressure for labour and birth protocol , incorporated six evidence -based complementary medicine ( CM ) techniques ; acupressure , relaxation , visualisation , breathing , massage , yoga techniques and incorporated facilitated partner support . R and omisation to the trial occurred at 24 - 36 weeks ' gestation , and participants attended a two-day antenatal education programme , plus st and ard care , or st and ard care alone . FINDINGS the overarching theme identified in the qualitative data was making sense of labour and birth . Women used information about normal birth physiology from the course to make sense of labour , and to utilise the CM techniques to support normal birth and reduce interventions in labour . Women 's , partners ' and midwives ' experience of the course and its use during birth gave rise to supporting themes such as : working for normal ; having a toolkit ; and finding what works . KEY CONCLUSIONS the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to underst and the physiology of normal labour and birth and enabled them to use evidence -based CM tools to support birth and reduce interventions . IMPLICATION S FOR PRACTICE the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women , partners and midwives . It appears to be an effective form of antenatal education that supports normal birth , and maternity services need to consider how they can reform current antenatal education in line with this evidence Objective . To evaluate the efficacy of acupuncture for labor stimulation . Methods . Nulliparous women at 38 weeks or greater were r and omized to traditional Chinese medicine ( TCM ) acupuncture , sham acupuncture , or usual care only groups . Acupuncture points LI4 , SP6 , BL32 , and BL54 were needled bilaterally . The primary outcome was time from enrollment to delivery . Secondary outcomes included rates of spontaneous labor and cesarean delivery . Medical records were abstract ed for maternal demographic , medical , and delivery outcome data . ANOVA , Student 's t-test , Chi-square , and Kaplan – Meier statistics were used to compare groups . Results . Eighty-nine women were enrolled and r and omized . Maternal age , gestational age , prior acupuncture experience , tobacco , alcohol and drug use , gravida , and history of gynecological surgery were similar among the groups . There were no statistically significant differences among groups for time from enrollment to delivery ( p = 0.20 ) , rates of spontaneous labor ( p = 0.66 ) , or rates of cesarean delivery ( p = 0.37 ) . Rates of maternal and neonatal outcomes were not significantly different . Conclusion . TCM acupuncture was not effective in initiating spontaneous labor or reducing the rate of cesarean delivery compared with sham acupuncture or usual medical care Please cite this paper as : Modlock J , Nielsen B , Uldbjerg N. Acupuncture for the induction of labour :  a double‐blind r and omised controlled study . BJOG 2010;117:1255–1261 Abstract Aims : To evaluate the efficacy of acupuncture , and sweeping of the fetal membranes , as methods for induction of labor . Methods : Four hundred and seven pregnant women with normal singleton pregnancies and cephalic presentations were r and omized at three delivery wards in Denmark at day 290 of gestation into groups of acupuncture , sweeping , acupuncture and sweeping and controls . The primary objective was to compare the proportion of women going into labor before induction of labor at 294 days in the four groups . The secondary objective was to compare the combined groups : with and without acupuncture , and with and without sweeping of the fetal membranes . The midwives , completing the forms for the trial at labor or induction , were blinded to group assessment s. Results : Four hundred and seventeen women were r and omized . Ten were excluded after r and omization . One hundred and four women were r and omized to acupuncture , 103 to sweeping of the membranes , 100 to both acupuncture and sweeping , and 100 were r and omized to the control group . Comparison of the four groups demonstrated no significant difference in the number of women achieving spontaneous labor before planned induction . No difference was demonstrated by comparing the combined groups treated with acupuncture with the groups not treated with acupuncture ( P=0.76 ) . However , significantly more women went into labor before planned induction ( P=0.02 ) in the combined groups receiving sweeping , compared with the groups not treated with sweeping . Conclusions : Acupuncture at 41 + weeks of gestation did not reduce the need for induction . The study was of a sufficient size to demonstrate , in parallel , that sweeping of the fetal membranes significantly reduced the need of induction , sparing about 15 % for formal induction of labor Objective To measure the serum levels of interleukin (IL)-8 , prostagl and in ( PG ) F2α and β-endorphin in parturients with acupuncture treatment and in controls to clarify the effect of acupuncture and duration of labor on the serum levels of substances active in cervical ripening and dilatation . Methods A matched pair study was performed involving 80 women with and without prenatal acupuncture treatment , matched for age and parity . Serum levels of IL-8 , PGF2α , and β-endorphin were measured in serum sample s taken after delivery by use of enzyme-linked immunosorbent assay , enzyme immunoassay , and immunoradiometric assay , respectively . Results The mean difference in total duration of labor between matched pairs with and without acupuncture was-136.5 minutes ( 95 % confidence interval [ CI ] 191.1 minutes,-81.9 minutes ; paired t test , P < .001 ) . The mean difference of the duration of the first and second stages of labor between matched pairs with and without acupuncture was-138.8 minutes ( 95 % CI 188.6,-89.0 minutes ; paired t test , P < .001 ) and 2.3 minutes ( 95 % CI 15.5 , 20.1 minutes ; paired t test , P = 55 .8 ) , respectively . The geometric means of ratios of IL-8 , PGF2α , and β-endorphin between matched pairs in women with and without acupuncture showed no statistically significant differences . Serum levels of IL-8 , PGF2α , and β-endorphin were not significantly correlated with the duration of the first and second stages of labor . Conclusion Prenatal acupuncture treatment significantly reduces the duration of labor and may be a valuable tool in prenatal preparation . Serum levels of IL-8 , PGF2α and β-endorphin are not significantly influenced by acupuncture and are therefore not likely to mediate acupuncture-related effects during labor Purpose The present study was aim ed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score < 7 and to observe the characteristics of labor in both methods . Methods As much as 67 pregnant women with Bishop score < 7 , single cephalic presentation with gestational age confirmed by first-trimester ultrasound , reactive cardiotocography , and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected . They were r and omized into 2 groups : electroacupuncture ( AC ) or misoprostol ( M ) . Results There were no significant differences regarding age , gestational age , fetal weight , parity , Bishop score , or indication for induction . Labor was the main outcome , which was obtained in both groups without significant difference regarding frequency ( p = 0.07 ) and time of induction ( p = 0.29 ) . Absence of obstetric complication , higher duration of labor ( p = 0.036 ) , and tendency to a higher satisfaction of the patients ( p = 0.046 ) were observed among patients of group AC . Higher frequency of cesarean sections ( p = 0.014 ) and obstetric complications ( 9.3 % ) were observed among patients of group M. Conclusions Our results showed that electroacupuncture can be used to obtain cervical ripening , with similar results as compared with misoprostol , with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications Background : Cervical ripening is one of the main stages of initiation labor . Acupressure in Chinese medicine is considered as an invasive technique , which through reliving oxytocin ripens the cervix . Acupoint Sanyinjiao ( SP6 ) was selected in this study because it is the acupoint selected in gynecology and it is easy for women to locate and apply pressure without medical assistance . Objectives : The aim of this study was to determine the effect of acupressure on cervical ripening . Patients and Methods : In this r and omized clinical trial , 150 primigravida with term pregnancy who had referred to Deziani hospital in Gorgan were chosen and divided to three groups : in the first group acupressure was done by the research er while in the second groups this was performed by the mother her self , and the third group served as a control and only received routine care . For both intervention groups the pressure was applied on Sp6 for about 20 minutes during one to five days . Elements were checked from cervical ripening at 48 and 96 hours after intervention and at the time of hospitalization . The tools for gathering information included demographic characteristics and midwifery history question naire , daily records and follow up forms . Content validity was used for validity of tools . Reliability of the observation check-list and physical examination was confirmed by inter-rater scores ( inter observer ) , and daily records by test-re-test . Data was analyzed by analysis of variance ( ANOVA ) , Kruskal-Wallis and Chi-squared tests ( P ≤ 0.05 ) . Results : There was a significant difference between mothers ’ educations in the three groups . Most of the mothers ( 59.5 % ) in the research er-performed acupressure group had secondary education . Cervical ripening was significantly different between the three groups after 48 hours ( P ≤ 0.05 ) , yet there was no significant difference after 96 hours and at the time of admission . Mean Bishop score was enhanced after 48 hours in the research er-performed acupressure group ( P ≤ 0.021 ) and the self-performed acupressure group ( P ≤ 0.007 ) in comparison to the control group . Conclusions : The results showed that acupressure is a safe technique and leads to cervical ripening . Thus , regarding the desired results that were achieved when mothers applied acupressure themselves , it could be suggested that it is beneficial for mothers to be trained to apply this method at home Please cite this paper as : MacKenzie I , Xu J , Cusick C , Midwinter‐Morten H , Meacher H , Mollison J , Brock M. Acupuncture for pain relief during induced labour in nulliparae : a r and omised controlled study . BJOG 2011;118:440–447 Objective To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use . Design Open-label , assessor blind , r and omised controlled trial . Setting 2 public hospitals in Sydney , Australia . Population 176 nulliparous women with low-risk pregnancies , attending hospital-based antenatal clinics . Methods and intervention The Complementary Therapies for Labour and Birth protocol , based on the She Births and acupressure for labour and birth courses , incorporated 6 evidence -based complementary medicine techniques : acupressure , visualisation and relaxation , breathing , massage , yoga techniques , and facilitated partner support . R and omisation occurred at 24–36 weeks ’ gestation , and participants attended a 2-day antenatal education programme plus st and ard care , or st and ard care alone . Main outcome measures Rate of analgesic epidural use . Secondary : onset of labour , augmentation , mode of birth , newborn outcomes . Results There was a significant difference in epidural use between the 2 groups : study group ( 23.9 % ) st and ard care ( 68.7 % ; risk ratio ( RR ) 0.37 ( 95 % CI 0.25 to 0.55 ) , p≤0.001 ) . The study group participants reported a reduced rate of augmentation ( RR=0.54 ( 95 % CI 0.38 to 0.77 ) , p< 
    Output:
    