BACKGROUND AND PURPOSE:

• In an update to a 2005 review, Finucane et al. (Cochrane Reviews, 2020) assess the efficacy and safety of membrane sweeping for induction of labor in women at or near term (≥36 weeks’ gestation)

METHODS:

• Systematic review and meta-analysis
• Data sources
  • Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) through 25 February 2019
• Inclusion criteria
  • Randomized and quasi-randomized controlled trials
  • Trials that compared membrane sweeping used for third trimester cervical ripening or labor induction with
    • Placebo/no treatment
    • Other methods of labor induction
• Study design and data analysis
  • 2 review authors independently assessed studies for inclusion, risk of bias and extracted data
  • Random-effects modelling was used throughout
  • Certainty of the evidence was assessed using the GRADE criteria

RESULTS:

• 44 studies (20 new to this update) | 6940 women

Membrane Sweeping vs No Treatment or Sham (40 studies)

Women in membrane sweeping group (low certainty evidence)

• May be more likely to have spontaneous onset of labor
  • Average risk ratio (aRR) 1.21 (95% CI, 1.08 to 1.34)
• May be less likely to experience induction
  • aRR 0.73 (95% CI, 0.56 to 0.94)

There may be little to no difference between groups for

• Cesarean delivery
  • aRR 0.94 (95% CI, 0.85 to 1.04)
• Spontaneous vaginal birth
  • aRR 1.03 (95% CI, 0.99 to 1.07)
• Maternal death or serious morbidity
  • aRR 0.83 (95% CI, 0.57 to 1.20)
• Neonatal perinatal death or serious morbidity
  • aRR 0.83 (95% CI, 0.59 to 1.17)

Membrane Sweeping vs Vaginal/Intracervical Prostaglandins (4 studies)

There may be little to no difference between groups for (low certainty evidence)

• Spontaneous onset of labor
  • aRR 1.24 (95% CI, 0.98 to 1.57)
• Induction
  • aRR 0.90 (95% CI, 0.56 to 1.45)
• Cesarean
  • aRR 0.69 (95% CI, 0.44 to 1.09)
• Spontaneous vaginal birth
  • aRR 1.12 (95% CI, 0.95 to 1.32)
• Maternal death or serious morbidity
  • aRR 0.93 (95% CI, 0.27 to 3.21)
• Neonatal perinatal death or serious morbidity
  • aRR 0.40 (95% CI, 0.12 to 1.33)

Membrane Sweeping vs IV Oxytocin +/- Amniotomy (1 study)

There may be little to no difference between groups for (low certainty evidence)

• Spontaneous onset of labor
  • aRR 1.32 (95% CI, 88 to 1.96)
• Induction
  • aRR 0.51 (95% CI, 0.05 to 5.42)
• Cesarean
  • aRR 0.69 (95% CI, 0.12 to 3.85)

Membrane Sweeping vs Vaginal/Oral Misoprostol (2 studies)

There may be little to no difference between groups for (low certainty evidence)

• Cesarean
  • RR 0.82 (95% CI, 0.31 to 2.17)

Once Weekly Membrane Sweep vs Twice Weekly Membrane Sweep vs Sham (1 study)

There may be little to no difference between groups for

• Induction
  • RR 1.19 (95% CI, 0.76 to 1.85)
• Cesarean
  • RR 0.93 (95% CI, 0.60 to 1.46)
• Spontaneous vaginal birth
  • RR 1.00 (95% CI, 0.86 to 1.17)
• Maternal death or serious morbidity
  • RR 0.78 (95% CI, 0.30 to 2.02)
• Neonatal death or serious neonatal perinatal morbidity
  • RR 2.00 (95% CI, 0.18 to 21.76)

CONCLUSION:

• Membrane sweeping may reduce induction of labor and be effective at achieving spontaneous labor onset in patients being managed expectantly
• No significant differences were identified between membrane sweeping and vaginal/intracervical prostaglandins
• Data was limited for other ripening options, but no differences were identified

Learn More – Primary Sources:

Membrane sweeping for induction of labour

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