Efficacy and safety of serial membrane sweeping to prevent post term pregnancy: a randomised study
Keywords:Serial membrane sweeping, Prevention of post term pregnancies
Background: Prolonged pregnancy is associated with increased perinatal mortality and morbidity. Elective induction of labor at 41 weeks gestation is practiced routinely to improve the outcome. Membrane sweeping is old and simple method to promote onset of labor. To improve the success rate of this method, multiple attempts of sweeping has been tried and found to be effective and safe. Our aim was to assess the safety and efficacy of serial membrane sweeping in prevention of post term pregnancies.
Methods: Participants were randomly assigned to serial membrane sweeping every 48 hours starting from 40 weeks until the labour commencement or up to 41 weeks of gestation. There was no intervention up to 41weeks in the control group. Labor was induced in women of both the groups who continued pregnancy beyond 41 weeks. Outcome measures include spontaneous onset of labor, mode of delivery, need of oxytocin for augmentation and maternal and fetal complications.
Results: Significant number of women had spontaneous onset of labor before 41 weeks (47/48) and delivered vaginally in contrast to control group (23/50). There is significantly less need of oxytocin in study group. The prevention remained consistent and not dependent on parity and bishop score. Significant number in control group had meconium stained liquor. No other maternal or fetal complications noted.Conclusions: Serial membrane sweeping is both safe and effective in the prevention of pregnancy beyond 41 weeks. Hence reduces the post term pregnancy, need for induction of labour and related risks in low pregnancies.
American College of Obstetricians and Gynecologists. Management of Postterm Pregnancy. ACOG Practice Bulletin No.55. Washington, DC: ACOG. 2004.
Divon, MY, Ferber, A, Sanderson, M et al. A functional definition of prolonged pregnancy based on daily fetal and neonatal mortality rates. Ultrasound Obstet Gynecol. 2004;23:423.
Bakketeig L, Bergsjo P. Postterm pregnancy: magnitude of the problem. In Chalmers I, Enkin MW, Keirse MJNC, editors. Effective Care in pregnancy and Childbirth. Oxoford, UK: Oxoford University Press.1989;765-75.
Hilder L, Costeloe K, Thilaganathan B. Prolonged pregnancy: Evaluating gestation specific risks of fetal and infant mortality. BJOG. 1998;105:169-73.
Hannah ME. Postterm pregnancy: should all women have labour induced? A review of the literature. Fetal and Maternal Medicine Review. 1993;5:3–17.
Royal College of Obstetricians and Gynecologists. Induction of labour. Evidence based clinical Guideline No. 9, June 2001. London: RCOG Press.
Munro KJ, Jhonson RW, Philips MH. Historical Review of British Obstetrics and Gynaecology. 1800-1950. Edinburgh,UK: Livingstone,1954.
Dare FO, Oboro VO. The role membrane stripping in prevention of post term pregnancy: a randomized clinical trial in Ile-Ife, Nigeria. J Obstet Gynaecol. 2002;22:283-6.
Mitchell MD, Flint APF, Bibby J, Brunt J, Anderson ABM, Turnbull AC. Rapid increase in plasma prostaglandin concentrations after vaginal examination and amniotomy. Br Med J. 1977;2:1183–5.
Keirse MJ, Thiery M, Parewijck W, Mitchell MD. Chronic stimulation of uterine prostaglandin synthesis during cervical ripening before the onset of labor. Prostaglandins. 1983:25:671-82.
McColgin SW, Bennet WA, Roach H, Cowan BD, Martin JN, Morrison JC. Parturitional factors associated with membrane stripping. Am J Obstet Gynecol. 1993;169:71–7.
Boulvain M, Irion O, Marcoux S, Fraser W. Sweeping the membranes to prevent post-term pregnancy and to induce labour: a systematic review. Br J Obstet Gynaecol. 1999;106(5):481–5.
Boulvain M, Irion O. Stripping/sweeping the membranes for inducing or preventing post-term pregnancy. Cochrane Database Syst Rev. 2004;(3):CD001328.
Wiriyasirizvaj B, Vutyavanich T, Ruangsri R. A randomized controlled trial of membrane stripping at term to promote labour. Obstet Gynecol. 1996;87:767–70.
Goldenberg M, Dulitzky M, Feldman B, Zolti M, Bider D. Stretching of the cervix and stripping of the membranes at term: a randomized controlled study. Eur J Obstet Gynecol Reprod Biol. 1996;66:129–32.
el-Torkey M, Grant JM. Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy. Br J Obstet Gynaecol. 992;99(6):455–8.
Cammu H, Haitsma V. Sweeping of the membranes at 39 weeks in nulliparous women: a randomized controlled trial. Br J Obstet Gynaecol. 1998;105(1):41–4.
Wong SF, Hui SK, Choi H, Ho LC. Sweeping of membranes in formal induction of labour. BJOG. 2002;109:632–5.
de Miranda E, van der Bom JG, Bonsel GJ, Bleker OP, Rosendaal FR. Membrane sweeping and prevention of post-term pregnancy in low-risk pregnancies: a randomized controlled trial. BJOG. 2006;113:402–8.
Berghella V, Rogers RA, Lescale K. Stripping of membranes as a safe method to reduce prolonged pregnancies. Obstet Gynecol. 1996;87:927–31.
Magann EF, McNamara MJ, Whitworth NS, Chauhan SP, Thorpe RA, Morrison JC: Can we decrease postdatism in women with an unfavourable cervix and a negative fetal fi bronectin test result at term by serial membrane sweeping? Am J Obstet Gynecol. 1998;179:890–4.
McColgin SW, Patrissi GA, Morrison JC: Stripping the fetal membranes at term: is the procedure safe and effi cacious? J Reprod Med. 1990;35:811–4.
Gupta R, Vasishta K, Sawhney H, Ray P: Safety and effi cacy of stripping of membranes at term. Int J Gynaecol Obstet. 1998;60:115–121.
Swann, RO. Induction of labour by stripping membranes. Obstet Gynecol. 1958;11:74–8.
Weissberg, SM, Spellacy, WM. Membrane stripping to induce labour. J Reprod Med. 1977;19:125–127.
Epley SL, Johnson SR, Goplerud CP. The morbidity of membrane stripping. J Iowa Med Soc. 1984;74:252-5.
Foong LC, Vanaja K, Tan G, Chua S. Membrane sweeping in conjunction with induction. Obstet Gynecol. 2000;96:539–42.
Tan PC, Jacob R, Omar SZ .Membrane sweeping at initiation of formal labor induction: a randomized controlled trial. Obstet Gynecol. 2006:107(3):569–77.