Membrane sweeping added to formal induction method to increase the spontaneous vaginal delivery: a meta-analysis

Abstract

MS added to formal induction significantly increased vaginal delivery rates, especially in nulliparas compared with formal induction alone. Notably, there are no obvious side effects of MS. Meanwhile, more RCTs studies are needed to investigate the side effects of MS on instrumental delivery, postpartum hemorrhage, and cervical laceration.

Review of Evidence‐Based Methods for Successful Labor Induction

“…In a 2018 meta-analysis of 6 RCTs (N = 1133 participants), Liu and colleagues compared 2 groups of participants: cervical balloon (30-60 mL fill) followed by standard dose oxytocin for IOL or cervical balloon with simultaneous initiation of oxytocin. 27 They found that multiparous participants in both groups were equally likely to give birth within 24 hours. However, nulliparous participants using a cervical balloon with simultaneous synthetic oxytocin experienced a 32% increased likelihood of birth within 24 hours (RR, 1.32; 95% CI, 1.12-1.55) compared with nulliparous participants using the cervical balloon with the later addition of synthetic oxytocin.…”

“…However, parity influenced outcomes; for nulliparous participants there was a 32% increase in spontaneous vaginal birth within 48 hours (RR, 1.32; 95% CI, 1.18‐1.48) with first‐examination membrane sweeping, whereas there were no differences in rates of spontaneous vaginal birth in 48 hours in multiparous participants. No adverse maternal or neonatal outcomes were noted with membrane sweeping 27 . Thus, there appear to be advantages for pregnant people of having their membranes swept, both in terms of avoiding labor induction and for increasing the likelihood of spontaneous vaginal birth in the first 2 days of IOL when used to initiate induction in nulliparous people.…”

“…There is also recent evidence that parity may influence the effectiveness of combination cervical ripening methods involving cervical balloons plus oxytocin. In a 2018 meta‐analysis of 6 RCTs (N = 1133 participants), Liu and colleagues compared 2 groups of participants: cervical balloon (30‐60 mL fill) followed by standard dose oxytocin for IOL or cervical balloon with simultaneous initiation of oxytocin 27 . They found that multiparous participants in both groups were equally likely to give birth within 24 hours.…”

“…In a 2018 meta-analysis (4 trials, N = 1377 participants), Liu et al examined the influence of membrane sweeping during the first cervical examination with IOL on participants' chances of achieving vaginal birth within 48 hours. 27 The labor of all participants included in this study was induced using a similar combination of mechanical or pharmacologic interventions, either with or without membrane sweeping for the control and comparison groups. Liu et al found an increase in spontaneous vaginal birth within 48 hours if IOL was initiated with membrane sweeping.…”

“…No adverse maternal or neonatal outcomes were noted with membrane sweeping. 27 Thus, there appear to be advantages for pregnant people of having their membranes swept, both in terms of avoiding labor induction and for increasing the likelihood of spontaneous vaginal birth in the first 2 days of IOL when used to initiate induction in nulliparous people.…”