FPIN's Help Desk Answers
Membrane Sweeping to Decrease Rates of Postdate Induction
Am Fam Physician. 2017 Jan 1;95(1):35-36.
Does membrane sweeping at term reduce rates of postdate induction?
In uncomplicated pregnancies, membrane sweeping at 38 to 40 weeks' gestation safely decreases the rate of postdate inductions. Membrane sweeping increases the incidence of spontaneous labor, especially in the subsequent seven days, and results in fewer pregnancies extending beyond 41 weeks. (Strength of Recommendation: A, based on a systematic review and meta-analysis of randomized controlled trials [RCTs].)
Membrane sweeping or stripping is routinely used in late pregnancy. It involves inserting a finger into the cervical os and sweeping it circumferentially to separate the fetal membranes from the uterus. A 2005 Cochrane review evaluated membrane sweeping for induction of labor in 22 RCTs with a total of 2,797 pregnant women at term.1 Sweeping was primarily compared with no intervention, although several small trials compared it with prostaglandin or oxytocin (Pitocin) administration. Time to spontaneous delivery was 2.5 days shorter in the intervention group (10 trials; N = 1,580; mean difference [MD] = −2.5; 95% confidence interval [CI], −3.0 to −2.0), and there was a decreased need for formal labor induction (12 trials; N = 1,493; risk ratio [RR] = 0.28; 95% CI, 0.15 to 0.5). After membrane sweeping, fewer patients were undelivered after 48 hours (five trials; N = 726; RR = 0.77; 95% CI, 0.70 to 0.84), after one week (nine trials; N = 1,375; RR = 0.71; 95% CI, 0.65 to 0.78), by 41 weeks' gestation (six trials; N = 937; RR = 0.59; 95% CI, 0.46 to 0.74), and by 42 weeks' gestation (six trials; N = 722; RR = 0.28; 95% CI, 0.15 to 0.50). There was no difference in rates of cesarean delivery or serious maternal-fetal events compared with no intervention, prostaglandin administration, or oxytocin administration, although patients who underwent membrane sweeping had more minor bleeding and irregular contractions.
A 2010 RCT compared the effects of membrane sweeping at 38
REFERENCESshow all references
1. Boulvain M, Stan C, Irion O. Membrane sweeping for induction of labor. Cochrane Database Syst Rev. 2005;(1):CD000451....
2. Yildirim G, Güngördük K, Karadag OI, Aslan H, Turhan E, Ceylan Y. Membrane sweeping to induce labor in low-risk patients at term pregnancy: a randomized controlled trial. J Matern Fetal Neonatal Med. 2010;23(7):681–687.
3. 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(4):402–408.
4. ACOG committee opinion no. 579: definition of term pregnancy. Obstet Gynecol. 2013;122(5):1139–1140.
Help Desk Answers provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o=1025).
The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: firstname.lastname@example.org.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
A collection of FPIN's Help Desk Answers published in AFP is available at https://www.aafp.org/afp/hda.
Want to use this article elsewhere? Get Permissions