Experimental study reveals Effectiveness of membrane sweeping with cervical massage for pre-induction cervical ripening
The first stage of labor using artificial means instead of natural means is called induction of labor (IOL). The most frequent obstetrics operation is this one. In recent years, the rate has sharply increased. Pregnant women with diabetes mellitus, postdate pregnancies, preeclamptic patients, IUGR, and PPROM all undergo it. The technique employed should be efficient financially and have minimal negative effects since it is the most prevalent operation. Uterine pressure is more needed for an immature cervix than a ripe one.
Induced labor is associated with failure to progress, prolonged labor, fetal distress, and a rise in cesarean sections when the cervix is not mature enough to allow for a successful vaginal birth. Bishop scoring measures the ripening of the cervical papilla. When the bishop score is less than, cervical ripening treatments are suggested. Bishop’s scoring method for predicting vaginal delivery in multiparas at term while receiving IOL has been effective repeatedly. Although recognizing its general simplicity and use, it may be time to reconsider the Bishop Score assessment’s usefulness in predicting vaginal delivery in contemporary practice, especially in light of its expanding usage with nulliparous and preterm patients. Finding biomolecular, imaging, or other signals that predict the cervix’s preparation for vaginal delivery after IOL is difficult.
The ultimate goal would be to time IOL surgeries specifically to get the greatest outcomes for each pregnancy. It is common knowledge that pregnancies over the due date may result in issues for the fetus, the newborn, and the mother. Risks rise after 40 weeks of pregnancy and dramatically after 41 weeks, making this the most frequent reason for inducing labor in the hopes of a vaginal birth. The cervical ripening and labor induction procedures ideally call for hospital admission. However, individuals often choose against medical advice to wait for spontaneous labor pains because they feel uncomfortable. However, government hospitals are often overrun with patients in a growing nation like India. It is thus desirable to use any procedure that is both safe and efficient that might reduce hospital stays and monetary costs without endangering the health of the pregnant woman or the fetus. Membrane Sweeping (MS), a straightforward technique that is used all around the globe to encourage cervical ripening, is quite popular. It’s still unclear when membrane sweeping should be done to guarantee efficacy
An inexpensive and efficient cervical ripening and medical induction medication is misoprostol, a PGE1 analog. The aforementioned components could be taken orally or systemically, which is advantageous in tropical nations with few resources. Pregnant women’s particular requirements and worries are the main focus of cervical massage during pregnancy. This specific massage method is intended to lessen the stresses of bearing the additional weight, hormonal changes, and postural changes intrinsic to the prenatal period to improve physical and emotional wellbeing. Cervical massage develops as a complete method for encouraging relaxation, alleviating pain, and fostering peace for both the mother and the developing baby by fusing expert touch with a thorough knowledge of the pregnant body. The efficiency of cervical ripening may be increased, and labor to begin spontaneously before a formal induction treatment is required by combining membrane sweeping with cervical massage. This study compares the efficacy of membrane sweeping with cervical massage in terms of effectiveness. This study’s secondary goal is to compare the maternal and newborn morbidity connected to the two methods.
A total of 150 low-risk singleton pregnancies with a Modified Bishop Score (MBS) of fewer than five at 38 weeks of gestation were included. The experimental group received membrane sweeping with cervical massage, and the control group, which just received membrane sweeping, was randomly allocated to the participants. 48 hours after the intervention, changes in the MBS were used to gauge cervical favorability. Neonatal morbidity, membrane rupture, intrapartum and postpartum infections, and other complications were assessed.
The mean ages and MBS of the primigravidae in the two research groups at induction were similar. After the intervention, the trial group’s mean MBS was significantly higher than the control groups. Because of this, primigravidae observed a substantial change in the MBS after the operation. The experimental group’s adverse effects and neonatal morbidity were comparable, except cardiotocographic abnormalities were observed more often in the control group.
The results of the present investigation revealed that whereas spontaneous labour did not vary in a quantitatively meaningful way following the intervention, cervical massage is just as efficient as membrane sweeping in attaining cervical ripening for labor induction at term in primigravidae.
Cervical massage combined with membrane sweeping is an alternative to membrane sweeping that might be a suitable choice for pre-induction cervical ripening in term mothers. This is particularly true when the cervical os is closed, and membrane sweeping cannot be performed due to the lack of access.
In addition, the findings of the present research demonstrated that cervical massage and membrane sweep would not have a negative impact on the outcomes for the neonates. This research shows a possible decrease in the time needed for labor induction in the experimental group. This discovery is important because it may result in less medical intervention and more effective labor. Therefore, there was insufficient evidence to conclude that cervical massage amplifies the adverse outcomes for the mother or the newborn in the present investigation. As a result, this research demonstrated that membrane sweeping and cervical massage had similar effects on maternal and newborn outcomes. Thus, cervical massage is a safe intervention regarding the danger of infection and prelabor membrane rupture. Although the findings of this study are encouraging, it is important to acknowledge the need for more investigation. To completely demonstrate the effectiveness and safety of this intervention, larger sample sizes, different demographics, and long-term follow-ups are required. It would also be beneficial to look at any variances in results depending on unique patient characteristics.
Source: Supriya et al. / Indian Journal of Obstetrics and Gynecology Research 2024;11(1):47–52; https://doi.org/10.18231/j.ijogr.2024.009
