![]() What the implications are of these findings for clinical practice and/or further research? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low risk pregnant women. However, the results of this review suggest that this effect is significant from 38 weeks of gestation, and is not dependent upon the number or timing of membrane sweeps performed. This study clearly demonstrates that membrane sweeping is effective in promoting a spontaneous labour and thereby reducing the need for a formal induction of labour. What the results of this study add? The results from this meta-analysis add to the body of existing evidence around membrane sweeping. ) that women are offered a membrane sweep to promote spontaneous labour prior to arranging a formal induction of labour. For these reasons, it is currently recommended by The National Institute for Health and Care Excellence (NICE 2008 National Institute for Health and Care Excellence (NICE). Women's experiences of being induced for post-date pregnancy. 2010 Gatward H, Simpson M, Woodhart L, Stainton M. NHS reference costs 2014–2015 ), and the birth experience of women (Gatward et al. ,, ), as well as having an impact on NHS resources (Department of Health 2015 Department of Health. Cochrane Database of Systematic Reviews CD003101. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. ![]() 2014 Thomas J, Fairclough A, Kavanagh J, Kelly A. American Journal of Obstetrics and Gynecology 199: 34.e1– 31.e5. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns. Simpson and James 2008 Simpson K, James D. However, all of the induction methods carry some degree of risk in terms of the associated morbidities and effectiveness (Cunningham 2005 Cunningham F. Consequently, a formal induction of labour is usually offered to low-risk pregnant women between 41 and 42 weeks of pregnancy. Cochrane Database of Systematic Reviews CD004945. Induction of labour for improving birth outcomes for women at or beyond term. 2012 Gulmezoglu A, Crowther C, Middleton P, Heately E. What is already known on this subject? Research suggests that a pregnancy which exceeds 42 weeks of gestation is associated with an increased risk of perinatal morbidity and mortality (Gulmezoglu et al. The studies reported several varying outcomes for both maternal and foetal morbidities meta-analyses were performed where possible on each of these and found there to be no statistically significant differences in outcome between the intervention and control groups. The results revealed that membrane sweeping is advantageous in promoting spontaneous labour (RR = 1.205, 95% CI: 1.133–1.282, p = <.001), and reducing the formal induction of labour for postmaturity (RR = 0.523, 95% CI: 0.409–0.669, p = <.001). A total of seven studies consisting of 2252 participants were selected for the review and meta-analysis. Relative risk (RR) and its 95% confidence interval (CI) were used as pooled statistics. Based on articles published between 20, 12 electronic databases were searched. There were two perinatal deaths in each group.Ĭonclusions Membrane sweeping at 41 weeks can substantially reduce the proportion of women with post-term pregnancy.The aim of this study was to evaluate the efficacy and the safety of membrane sweeping in promoting spontaneous labour and reducing a formal induction of labour for postmaturity. Other obstetric outcomes and indicators of neonatal morbidity were similar in both groups. Adverse effects were similar in both the groups except for uncomplicated bleeding, which was reported more frequently in the sweeping group. Benefits were also seen in both subgroups (nulliparous: 57/198 versus 89/192 RR 0.62 NNT 6 and parous: 30/177 versus 60/175 RR 0.49 NNT 6 ). Results Serial sweeping of the membranes at 41 weeks decreased the risk of post-term pregnancy (87/375 versus 149/367 relative risk 0.57, 95% CI 0.46–0.71 number needed to treat 6 ). Secondary outcomes included adverse effects. ![]() Subgroup analyses were performed on nulliparous and parous women. Main outcome measures Post-term pregnancy (≥42 weeks). Methods Participants were randomly assigned to serial sweeping of the membranes (every 48 hours until labour commenced up to 42 weeks of gestation) or no intervention. Population A total of 742 low-risk pregnant women at 41 weeks of gestation. Setting Fifty-one primary care midwifery practices in the Netherlands. Objective To evaluate the effectiveness of membrane sweeping at 41 weeks for the prevention of post-term pregnancy.ĭesign A multicentre randomised controlled trial.
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