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Grand Rounds

How Effective is Membrane Sweeping When Inducing Labor?

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BACKGROUND AND PURPOSE:

  • It is suggested that membrane sweeping may help induce labor by releasing local prostaglandins, phospholipase A3 and oxytocin
  • Membrane sweeping could increase the likelihood of spontaneous labor within 48 hours
  • Liu et al. (Archives of Gynecology and Obstetrics, 2017) assessed the effect of membrane sweeping when added to induction of labor

METHODS:

  • Systematic review and meta-analysis
  • Eligible research included
    • RCT design
    • Two study arms
      • MS added to formal induction method compared to a control group in which formal induction without MS
    • Singleton fetus and cephalic presentation
    • Essential data for calculating the relative risk (RR) or odds ratio (OR) and 95% CI available
  • Membrane sweeping was performed during 37 and 42 weeks of gestation
  • Induction protocols
    • One trial only used prostaglandin E2 (PGE2) as control interventions
    • Other three trials were combined using amniotomy and oxytocin, or PGE2 alone
  • Primary outcome
    • Vaginal delivery
  • Secondary outcomes included adverse events
    • Meconium
    • NICU admission
    • Instrumental delivery

RESULTS:

  • Data was collected from four RCTs for a total of 1377 patients
  • The summary RR in the overall group was 1.12 (95% CI 1.05-1.18)
  • The summary RR in the nulliparous subgroup was 1.32 (95% CI 1.18-1.48)
  • Adverse events were not increased in the membrane stripping group

CONCLUSION:

  • Membrane sweeping added to formal induction increased vaginal delivery rates, especially in nulliparas
  • The authors suggest that more RCTs are needed to determine the association with instrumental delivery, postpartum hemorrhage, and cervical laceration

Learn More – Primary Sources:

Membrane sweeping added to formal induction method to increase the spontaneous vaginal delivery: a meta-analysis.

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