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Am Fam Physician. 2022;106(1):online

Author disclosure: No relevant financial relationships.

Details for This Review

Study Population: Patients who are pregnant with a live fetus at or near term (36 weeks or greater estimated gestational age) without indication for induction or urgent delivery

Efficacy End Points: Primary: spontaneous onset of labor, need for induction of labor, need for cesarean delivery, spontaneous vaginal delivery; secondary: instrument-assisted vaginal birth, epidural analgesia

Harm End Points: Primary: maternal death or serious morbidity, uterine hyperstimulation with or without fetal heart rate deceleration, neonatal death, serious perinatal morbidity; secondary: postpartum hemorrhage, uterine rupture, augmentation of labor

Narrative: Approximately 20% to 25% of deliveries occur after labor induction in middle-to high-income countries.1 Membrane sweeping is a common outpatient intervention associated with cervical dilatation assessment. 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. 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. The process of membrane sweeping leads to the release of phospholipase A2 and prostaglandin F, which directly contribute to cervical ripening through an inflammatory cascade.2

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This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://

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