Membrane sweep

Membrane sweep is a mechanical induction method that initiates labour. The method means that the examiner moves one or two fingers in the cervix and through circular movements releases the fetal membranes from the lower part of the uterus.

Question

What systematic reviews are there on the use of membrane sweep?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias.
SR = Systematic review; RCT = Randomized Control trial; MS = Membrane sweep (Hinnsvepning), FHR = Foetal heart rate; Nullipara = Woman who has never given birth.; Bishop score = Also known as cervix score is a pre-labour scoring system to assist in predicting whether induction of labour will be required.
Included studies Population/ Intervention Outcome
Finucane et al 2020 [1]
Study types: Randomised controlled trials and quasi‐randomised trials. The review included RCTs which cannot be blinded due to the nature of the intervention.
Comparisons: Studies comparing membrane sweeping for labour induction with placebo/no treatment or other methods for labour induction.
Included studies: 44 studies with a total of 6,940 participants were included in the meta-synthesises.
Population: Pregnant women carrying a live foetus at or near term (≥36 weeks' gestation).
Intervention: Amniotic membrane sweeping which was defined as the manual detachment of the inferior pole of the amniotic membrane from the lower uterine segment.
Effects: Spontaneous onset of labour, induction of labour, spontaneous vaginal birth, uterine hyperstimulation and maternal and infant mortality.
Adverse effects: Caesarean section, uterine rupture, admission to intensive care unit, septicaemia, neonatal sepsis, birth asphyxia, neonatal encephalopathy.
Secondary outcomes: Woman’s satisfaction, cost, apgar score, neonatal encephalopathy, perinatal death, instrumental vaginal birth, epidural analgesia, postpartum haemorrhage and augmentation of labour.
Authors’ conclusion: Membrane sweeping may be effective in achieving a spontaneous onset of labour, but the evidence for this was of low certainty. When compared to expectant management, it potentially reduces the incidence of formal induction of labour. Questions remain as to whether there is an optimal number of membrane sweeps and timings and gestation of these to facilitate induction of labour.
Avdiyovski et al 2019 [2]
Study types: Randomized control trials published in English between 2005 and 2016.
Comparisons: Studies comparing membrane sweep to no intervention or vaginal examination were only to assess bishop score.
Included studies: Seven studies with a total of 2,252 participants were included in the meta synthesis.
Population: Pregnant women with a low-risk singleton cephalic pregnancy of term (37–42 weeks.)
Intervention: Membrane sweep that have been performed on at least one occasion, and at least 72 hours prior to the formal induction of labour.
Effects: Effectiveness in promoting spontaneous labour, reducing formal induction of labour, Maternal- and foetal morbidity.
Adverse effect: Safety, for example caesarean section and pre-labour rupture of membrane.
Authors' conclusion:
“In conclusion, this meta-analysis demonstrated that membrane sweeping is both a safe and effective method of promoting a spontaneous labour and therefore reducing the formal induction of labour for post maturity. It was also able to demonstrate that membrane sweeping is effective when performed from 38 weeks of gestation, and that a single membrane sweep may be as effective as multiple membrane sweeps.”
Liu et al 2017 [3]
Study types: Randomized control trials. Reviews, observational studies, case reports or letters were excluded.
Comparisons: Formal induction without membrane sweeping.
Included studies: Four studies were included in the meta-synthesis.
Population: Women with singleton fetus and cephalic presentation.  Studies focusing on women with caesarean delivery or abnormal conditions such as fetal anomaly, intrauterine fetal deaths were excluded.
Intervention: Membrane sweep added to formal induction method.
Effects: The primary outcome were spontaneous vaginal delivery.
Secondary outcomes were meconium-stained liquor, admission to neonatal unit and instrumental delivery.
Authors' conclusion:
“In conclusion, MS added to formal induction significantly increase vaginal delivery rates compared with formal induction alone, especially in nulliparas. Notably, there are no obvious side effects of MS. Meanwhile, more RCT’s studies are needed to investigate the side effects of MS on instrumental delivery, postpartum haemorrhage, and cervical laceration.”
Mozurkewich et al 2011 [4]
Study types: High-quality systematic reviews SR and RCT were included in a hierarchical fashion. If SR’s were found only RCT’s published after the SR search date or that have been missed where included.
Comparisons: At least one control group (control, placebo or another method).
Included studies: 46 studies were included in the systematic review, whereof one Cochrane review and six RCT’s were dealing with membrane sweeping.
Population: Women undergoing induction of labour at term with a live fetus.
Studies dealing exclusively with subgroups of participants were also excluded.
Intervention: Pharmacologic, mechanical, investigational, and complementary and alternative medicine means of third trimester labour induction methods.
Effects: Had to include at least one of the outcomes specified by the Cochrane Collaboration induction of labour generic protocol:
Vaginal delivery not achieved within 24 hours, uterine hyperstimulation with FHR changes, caesarean section, serious neonatal morbidity or perinatal death, serious maternal morbidity or death.
Adverse effect: Outcomes related to both harm and benefits were included. Maternal satisfaction was included when available.
Authors' conclusion:
“Of the non-pharmacologic methods, membrane sweeping appeared to have the strongest evidence-base. It was successful in reducing post-term gestations without increasing clinically important harms.”

References

  1. Finucane EM, Murphy DJ, Biesty LM, Gyte GML, Cotter AM, Ryan EM, et al. Membrane sweeping for induction of labour. Cochrane Libr 2020.
  2. Avdiyovski H, Haith-Cooper M, Scally A. Membrane sweeping at term to promote spontaneous labour and reduce the likelihood of a formal induction of labour for postmaturity: a systematic review and meta-analysis. J Obstet Gynaecol 2019;39:54-62.
  3. Liu J, Song G, Meng T, Zhao G. Membrane sweeping added to formal induction method to increase the spontaneous vaginal delivery: a meta-analysis. Arch Gynecol Obstet 2018;297:623-30.
  4. Mozurkewich EL, Chilimigras JL, Berman DR, Perni UC, Romero VC, King VJ, et al. Methods of induction of labour: a systematic review. BMC Pregnancy Childbirth 2011;11:84-84.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 5/15/2020
Contact SBU: registrator@sbu.se
Report no: ut202019
Registration no: SBU 2020/86