The studies didn’t report on bleeding and irregular contractions, which are a known risk of MS What happens if the intervention does lead to a woman’s membranes rupturing at 38 weeks? Is she then going to possibly have to induce a baby that isn’t ready? Which again makes me worry about offering MS at 38 weeks. “The results indicated that there is an increased risk of PROM in the intervention group”. This brings us to a discussion on the risk of MS.Ħ of the studies reported on the outcome of pre-labour rupture of membranes (PROM) and the review states: “Although the overall prelabor rupture of membranes rates were similar, patients with membrane sweeping occurring at more than 1 cm cervical dilation may be at increased risk of prelabor rupture of membranes”.
In fact, the second study showed no difference between the study and control group. 2008, did not find a statistically significant increase in “ spontaneous” labour. (pg.57)Ĭan they really say MS worked if it was done 3 weeks before the woman went into labour?Īlso interesting to note is that 2 of the studies reviewed, Parlakgumus et al. This effect was significant in studies reporting results from 72 hours up to three weeks postintervention”. “(they) indicated a statistically significant effect of the intervention on the outcome measure, showing that membrane sweeping was associated with an increase in the incidence of spontaneous labour. 2014 Zamzami and al Senani 2014) and stated… The authors concluded Yes based on five of the studies reviewed ( De Miranda et al. So does this non-pharmaceutical, invasive (I personally think someone putting their fingers into my vagina is very invasive) induction technique actually work to induce labour? Great, they have admitted that membrane sweeping is an induction method and it is ‘somewhat’ invasive. What do they mean by this?Īs it turns out they mean “ pharmacological and more invasive methods of inducing birth” (pg. 55).īut there’s that word “ formal” again. They also point out the need to balance this very small risk with the “well-documented potential negative outcomes involved in formal methods of induction” (pg. Newnham’s works in Perth and he was awarded Senior Australia of the Year in 2020 for his work.Īnyway, I decided to read the actual paper and not just the abstract.įirstly I am glad the authors started by pointing out that it is pregnancies that exceed 42 weeks that have increased risk of adverse events and that because this risk is really low, only a very small portion of babies are actually at risk if they are not born before 42 weeks. John Newnham’s work stating that “ no pregnancy should end before 39 weeks unless there is a very strong reason“? Admittedly this is something I am very aware of as Prof. It involves a vaginal examination and should not be minimized by this language.Īnother big concern I have is that the authors are saying 38 weeks is “ term” and an appropriate time to induce a baby. I also really have trouble with them suggesting MS is an informal or casual procedure. Surely if MS works to put women into labour then it is an induction technique, and if these women truly went into spontaneous labour then they didn’t need MS? On one hand, they are saying it is an induction technique that reduces other “ formal induction” techniques and on the other hand they are saying MS puts women into spontaneous labour. However, I really have a problem with the phrases: “ spontaneous labour” and “ formal induction“.ĭoesn’t the statement “membrane sweeping is effective in promoting a spontaneous labour and thereby reducing the need for a formal induction of labour” contradict itself? Sounds great! and anyone just reading the abstract would probably start offering MS to all women at 38 weeks. This may result in a decreased risk of requiring a formal induction of labour for post maturity. We recommend therefore that there could be a reduction in the gestation at which membrane sweeping is offered from 40 weeks for primiparous women and 41 weeks for multiparous women to 38 weeks onwards for all low risk women without any increased risk of maternal or foetal morbidity. What the implications are of these findings for clinical practice and/or further research? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low risk pregnant women. However, the results of this review suggest that this effect is significant from 38 weeks of gestation, and is not dependent upon the number or timing of membrane sweeps performed.
clearly demonstrates that membrane sweeping is effective in promoting a spontaneous labour and thereby reducing the need for a formal induction of labour.
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