Is membrane sweeping a safe method for induction of labour?

Ireland: Induction of labour involves stimulating uterine contractions artificially to promote the onset of labour. There are several pharmacological, surgical and mechanical methods used to induce labour.

Membrane sweeping is a mechanical technique whereby a clinician inserts one or two fingers into the cervix and using a continuous circular sweeping motion detaches the inferior pole of the membranes from the lower uterine segment. This produces hormones that encourage effacement and dilatation potentially promoting labour.

Membrane sweeping may reduce the formal induction of labour.

The main objective of the study was to assess the effects and safety of membrane sweeping for induction of labour in women at or near term (≥ 36 weeks' gestation).

Two review authors independently assessed studies for inclusion, risk of bias and extracted data. Data were checked for accuracy. Disagreements were resolved by discussion, or by including a third review author. The certainty of the evidence was assessed using the GRADE approach. Randomized and quasi-randomized controlled trials comparing membrane sweeping used for third-trimester cervical ripening or labour induction with placebo/no treatment or other methods listed on a predefined list of labour induction methods. Cluster-randomized trials were eligible, but none were identified.

44 studies (20 new to this update), reporting data for 6940 women and their infants were included.Following comparisons were made:

1)Comparing membrane sweeping with no treatment/sham

2)Comparing membrane sweeping with vaginal/intracervical prostaglandins

3)Comparing membrane sweeping with intravenous oxytocin +/‐ amniotomy

4)Comparing membrane sweeping with vaginal/oral misoprostol

5)Comparing once weekly membrane sweep with twice‐weekly membrane sweep and a sham procedure

Three studies, providing data for 675 women, reported that women indicated favourably on their experience of membrane sweeping with one study reporting that 88% (n = 312) of women questioned in the postnatal period would choose membrane sweeping in the next pregnancy. Two studies reporting data for 290 women reported that membrane sweeping is more cost‐effective than using prostaglandins, although more research should be undertaken in this area.

Membrane sweeping may be effective in achieving a spontaneous onset of labour, but the evidence for this was of low certainty. When compared to expectant management, it potentially reduced the incidence of the formal induction of labour. Research is still ongoing to know whether there is an optimal number of membrane sweeps and timings and gestation of these to facilitate induction of labour concluded the authors.

For further reading click on the following link,

https://doi.org/10.1002/14651858.CD000451.pub3