In subgroup analyses, patients with cervical dilatation of 1 cm or greater had a relative risk of 1.10 (95% CI, 1.03 to 1.18), with a number needed to harm of 378 for prelabor rupture of membranes. In one RCT of 300 patients, there was no significant difference in rates of prelabor rupture of membranes when directly comparing those who underwent membrane sweeping with those who did not. This Cochrane review did not address the possibility of artificial rupture of membranes after membrane sweeping. A prospective trial of 542 patients who underwent membrane sweeping demonstrated a nonsignificant difference in all study outcomes between those who were positive for group B streptococci and those who were negative. There are concerns about the safety of membrane sweeping in carriers of group B streptococci. Sweeps can also be associated with bleeding from undiagnosed placenta previa or a low-lying placenta, which were not reported in this review because they were exclusion criteria. There was significant procedural heterogeneity across studies in the number of revolutions and standard depth of digital advancement in the membrane sweeping procedure. The Cochrane review included data from 19 countries, a breadth of resource settings, and urban and rural locations. 4, 5, 6, 7 Therefore, a safe, evidence-based modality such as membrane sweeping, which minimizes the need for formal induction, could have strong clinical utility. The results of ARRIVE are expected to increase the overall percentage of induced deliveries. expectant management at 39 weeks’ estimated gestational age. This Cochrane review predates the ARRIVE trial, which examined the safety of induction vs. Moderate heterogeneity was present in these included trials (Tau 2 = 0.00 I 2 = 37% P =. When sensitivity analyses were performed, including 12 of the 40 identified trials with low risk of bias, the result for spontaneous onset of labor was no longer statistically significant. The authors performed sensitivity analyses and excluded studies at high or unclear risk of bias for sequence generation or allocation concealment and studies with high or unclear risk of attrition. 3Ĭaveats Despite the good numbers needed to treat and large sample sizes, the studies included in the Cochrane review had low certainty of evidence as assessed using the GRADE approach. Even among those who had pain, 88% indicated they would opt for the procedure again. In one study in the Netherlands (n = 742), 88% of patients noted they would opt for membrane sweeping in subsequent pregnancies if it were offered 31% characterized the procedure as not painful, 51% as somewhat painful, and 17% as painful or very painful. Patient perception of membrane sweeping was positive. Other primary outcomes, including the likelihood of spontaneous vaginal delivery, were not significantly different.Įvidence certainty was low to moderate for all primary outcomes. This corresponds to an absolute risk reduction of 8.5% and a number needed to treat of 12 to prevent the need for further mechanical or pharmacologic induction of labor. Sixteen RCTs with 3,224 patients demonstrated a relative risk of 0.73 (95% CI, 0.56 to 0.94) for requiring labor induction. Seventeen randomized controlled trials (RCTs) with 3,170 patients compared membrane sweeping with expectant management, demonstrating a relative risk of 1.21 (95% CI, 1.08 to 1.34), an absolute risk difference of 12.5%, and a number needed to treat of 8 for spontaneous onset of labor. 2 The trials compared membrane sweeping with expectant management, sham membrane sweeps, and several induction methods, including vaginal and intracervical prostaglandins and intravenous oxytocin (Pitocin). 2Ī 2020 Cochrane review included 44 studies and 6,940 patients in 19 countries (14 from the United States). The process of membrane sweeping leads to the release of phospholipase A2 and prostaglandin F 2α, which directly contribute to cervical ripening through an inflammatory cascade. Successful performance of this procedure can decrease the need for formal induction with pharmacologic or mechanical methods or the need for hospitalization or advanced monitoring. Membrane sweeping is the advancement of one or two fingers through the internal cervical os to the lower uterine segment, followed by a circular sweeping movement between the amniotic membrane and the lower uterine segment. 1 Membrane sweeping is a common outpatient intervention associated with cervical dilatation assessment. Narrative Approximately 20% to 25% of deliveries occur after labor induction in middle-to high-income countries.
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