Stripping/sweeping the membranes for inducing labour or preventing post-term
pregnancy
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A substantive amendment to this systematic review was last made on 12 May
1998. Cochrane reviews are regularly checked and updated if necessary.
Background: Stripping or sweeping of the membranes aims to initiate labour
through a cascade of physiological events. These may reduce pregnancy
duration or pre-empt formal induction of labour with either oxytocin,
prostaglandins or amniotomy.
Objectives: The objective of this review was to assess the effects of
membrane sweeping to promote or induce labour on maternal and perinatal
outcomes.
Search strategy: We searched the Cochrane Pregnancy and Childbirth Group
trials register and the Cochrane Controlled Trials Register (last searched
April 1998).
Selection criteria: Adequately controlled trials of digital separation of the
membranes from the lower uterine segment for inducing labour or for
preventing post-term pregnancy, compared to either no vaginal examination or
vaginal examination for cervical assessment only without the intention to
detach the membranes.
Data collection and analysis: Two reviewers assessed trial quality and
extracted data.
Main results: Fourteen trials were included. Sweeping of the membranes,
performed as a general policy in women at term, was associated with reduced
duration of pregnancy and the frequency of pregnancy continuing beyond 41
weeks (relative risk 0.42, 95% confidence interval 0.19 to 0.93, random
effects model) and 42 weeks. After sweeping of the membranes, there was a 17%
risk reduction (confidence interval 6 to 29%, random effects model) in the
use of more formal methods for labour induction. There was no difference in
the mode of delivery or in the risk of infection. Discomfort during vaginal
examination and other adverse effects (bleeding, irregular contractions) were
more frequently reported by women allocated to sweeping.
Reviewers' conclusions: Routine use of sweeping of membranes from 38 weeks of
pregnancy onwards does not seem to produce clinically important benefits.
When used as a means for induction of labour, the reduction in the use of
more formal methods of induction needs to be balanced against women's
discomfort and other adverse effects.
Citation: Boulvain M, Irion O. Stripping/sweeping the membranes for inducing
labour or preventing post-term pregnancy (Cochrane Review). In: The Cochrane
Library, Issue 1, 2000. Oxford: Update Software.
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Robert Modugno MD MBA FACOG
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Marietta, GA
