Membrane Sweeping for Prevention of Post-Maturity in Low-Risk Term Pregnancies: A Randomized Controlled Trial
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- Category: Vol. 80, March 2012
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Membrane Sweeping for Prevention of Post-Maturity in Low-Risk Term Pregnancies: A Randomized Controlled Trial,ZAKIA M. IBRAHIM, MOHAMED H. SARAYA, KHALED M. ELNAHAS and MAMDOUH E. SAID
Abstract
Objective: To study the efficacy of membrane sweeping at term pregnancy for initiation of labor and prevention of post-maturity and its’ co-morbidity.
Study Design: A randomized controlled trial was conducted at the Department of Obstetrics and Gynecology at Suez Canal University Hospital from January 2010 to January 2011. The study was approved by our ethical committee at Suez Canal University Hospital. An informed consent was obtained from all patients enrolled in the study. All eligible patients who reached 38 weeks during the study period were randomized alternatively into one of two equal groups 40 pregnant women each. The study group underwent weekly stripping of mem-branes. The control group was managed conservatively until labor ensued. The primary outcome was to assess if membrane sweeping shortened the interval to spontaneous onset of labor as compared to the control group. Secondary outcomes were: Mode of delivery, complications (including occurrence of premature rupture of membrane, maternal infection, neonatal infection and occurrence of side effects such as pain, bleeding).
Results: Sweeping of the membranes reduces the interval to spontaneous onset of labor, however, this reduction was not statistically significant were the probability value for a Fisher exact test was >0.05. Thirty-seven of the forty women in the membrane sweeping group (92.5%) compared to thirty-four of the forty (85%) in the control group delivered sponta-neously before completion of 41 weeks of gestation. As for the mode of delivery there was no statistically significant difference between the membrane sweeping and the control groups as 97.5% had spontaneous vaginal delivery and only one patient in each group was delivered by CS. The incidence of complications and side-effects were very low in both group. Eighty-five percent of the patients in the membrane swapping group had no complications compared to 92.5% in the control group. One patient in study group had pre-labor rupture of membranes compared two women in the control group. In the membrane sweeping group, two women experienced minor per vaginal spotting and three patients complained of pain or discomfort and uterine cramping during or shortly after the procedure. While only one patient in the control group, complained of irregular uterine cramping. No fetal morbidities occurred in both groups.
Conclusion: Although membrane sweeping did not appear to significantly reduce the duration of gestation, however, being a safe and simple procedure and carries no significant maternal or fetal risks we find no harm in its’ employment on routine basis in low risk term pregnancies as it may help, in the least, in ripening of the cervix.