Membrane sweeping for induction of labour

 

Abstract

Background

Sweeping of the membranes, also named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician's finger is introduced into the cervical os. Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing local production of prostaglandins and, thus, reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.

Objectives

To determine the effects of membrane sweeping for third trimester induction of labour.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group trials register (6 July 2004) and bibliographies of relevant papers.

We updated this search on 31 July 2009 and added the results to the awaiting classification section.

Selection criteria

Clinical trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.

Data collection and analysis

A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.

Main results

Twenty-two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). There was no evidence of a difference in the risk of maternal or neonatal infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit.

Authors' 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.

[Note: The 11 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

 

Plain language summary

Membrane sweeping for induction of labour

Sweeping the membranes is effective in bringing on labour but causes discomfort, some bleeding and irregular contractions.

Sweeping the membranes during a cervical examination is done to bring on labour in women at term. The review of trials found that sweeping brings on labour and is generally safe where there are no other complications. Sweeping reduces the need for other methods of labour induction such as oxytocin or prostaglandins. The review also found that sweeping can cause discomfort during the procedure, some bleeding and irregular contractions.

 

摘要

背景

羊膜環掃術引產

羊膜環掃術(Sweeping of the membranes)，也可稱為羊膜剝離術，是一種相對簡單的技術，不需要住院。在內診時，醫師將手指伸入子宮頸口做環掃動作，以剝離子宮頸下段與羊膜下端間的空隙。這種動作可藉局部增加前列腺素的製造而誘發陣痛，進而縮短孕期長度，甚至可先發製人的取代如催產素、前列腺素，或破水等制式引產方式，達到催生的目的。。這是一系列促使子宮頸成熟和引產所使用的標準化方法之回顧分析。

目標

確認第三孕期，使用羊膜環掃術引產的效果。

搜尋策略

我們搜查了Cochrane懷孕和分娩組試驗登記冊(2004年7月6日)和書目的相關文件。

選擇標準

比較第三孕期使用羊膜環掃術，促進子宮頸成熟或引產的臨床效果。對照組包括使用安慰劑、不處置，或其他已列為可引產的方法。

資料收集與分析

其策略是發展可以處理大量和複雜性跟引產有關的試驗數據。這涉及兩階段數據萃取的方法。

主要結論

共納入22個有關羊膜環掃術的臨床試驗(2797名婦女)，其中20個試驗是以不處置作對照組，3個試驗是以前列腺素作對照組以及一個試驗是以催產素作對照組(兩項研究報告使用一個以上的對照組).在各群組… 至1.15)。足月產婦例行羊膜環掃術，可縮短孕期長度,降低懷孕超過41週的頻率(RR 0.59， 5 ％ CI 為0.46至0.74)和懷孕超過42週的頻率(RR 0.28，95 ％ CI為0.15至0.5)。必須8名婦女實行羊膜環掃術,才能避免一次制式的引產方式。在各群組之間,目前還沒有任何證據顯示母體或新生兒感染率的差異。使用羊膜環掃術的產婦較常發生陰道檢查時的不舒服和其他負面的影響(如出血，不規則收縮)。比較羊膜環掃術和前列腺素的研究，因樣本數有限，無法提供有利的結論。

作者結論

懷孕38週起，例行使用羊膜環掃術，似乎並沒有獲得臨床上重大的好處。作為一種引產的手段，不能為了減少使用較制式的引產方法，而忽略了婦女的不舒適感和其他負面的影響。

翻譯人

本摘要由周產期醫學會(Taiwan Society of Perinatology)黃宣蓉翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

羊膜環掃術能有效引產，但會造成產婦不舒服，出血和不規則宮縮。足月產婦在內診時以羊膜環掃術引產，是普遍安全的方法，並且沒有其他併發症。羊膜環掃術可減少使用其他引產的方法，如催產素或前列腺素。羊膜環掃過程中可能會導致不舒服，一些出血和不規則宮縮。