Sweeping of the membranes at 39 weeks in nulliparous women: a randomised controlled trial. Does sweeping of membranes beyond 40 weeks reduce the need for formal induction of labour? Sweeping the membranes: a valid procedure in stimulating the onset of labour? Sweeping of the membranes is an effective method of induction of labour in prolonged pregnancy: a report of a randomized trial. Does sweeping of the membranes reduce the need for formal induction of labour? A randomised controlled trial. Sweeping of the membranes versus uterine stimulation by oxytocin in nulliparous women. A randomized controlled trial. A comparative study of membrane stripping and nonstripping for induction of labor in uncomplicated term pregnancy. Stripping of membranes as a safe method to reduce prolonged pregnancies. Can we decrease postdatism in women with an unfavorable cervix and a negative fetal fibronectin test result at term by serial membrane sweeping? Stripping membranes at term: can it safely reduce the incidence of post-term pregnancies? Safety and efficacy of stripping of membranes at term. Membrane sweeping versus dinoprostone vaginal insert in the management of pregnancies beyond 41 weeks with an unfavorable cervix. A randomized controlled trial of membrane stripping at term to promote labor. The role of membrane stripping in prevention of post-term pregnancy: a randomised clinical trial in Ile-lfe, Nigeria. Membrane stripping to induce labor. Management of pregnancies beyond forty-one weeks' gestation with an unfavorable cervix. Stretching of the cervix and stripping of the membranes at term: a randomised controlled study. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial. Stripping the fetal membranes at term. Is the procedure safe and efficacious?
To determine whether weekly sweeping of the membranes from 39 weeks of gestation results in a reduction in the number of women reaching 41 completed weeks and subsequently in a reduction of the number of women who will need induction of labour.
                Randomised controlled trial.
                Two hundred and seventy-eight nulliparous women, who were seen at the antenatal clinic of a university teaching hospital, were randomly allocated at 39 weeks of gestation to receive on a weekly basis either sweeping of the membranes (n = 140) or a routine pelvic examination (n = 138).
                The time interval between randomisation and delivery, the incidence of prolonged pregnancy (i.e. > 41 completed weeks), and the incidence of induction of labour.
                In 24 women (17%) sweeping of the membranes was not possible. Fifty-three women (38%) in the sweeping group and 50 women (36%) in the control group were delivered within one week after randomisation. Women allocated to sweeping showed a trend towards having a shorter randomisation-delivery interval: 9.4 days versus 10.6 days in the controls (P = 0.087). Sweeping had no statistically significant effect on the mean duration of pregnancy (282.8 days in the sweeping group versus 283.8 days in the control group, P = 0.127). The need for induction of labour was significantly reduced in those women who underwent sweeping (11% versus 26%, P = 0.004), merely as a result of a decrease in the number of women that exceeded 41 weeks (19% versus 33%, P = 0.016).
                Sweeping of the membranes weekly from 39 weeks does not increase the number of women who will deliver within the first week but significantly decreases the number that will reach 41 weeks. Induction of labour then becomes less necessary. To assess the efficacy of sweeping of membranes beyond 40 weeks of gestation in reducing the incidence of induction of labour, when induction was planned at 42 weeks.
                Prospective randomised controlled trial.
                A regional obstetric unit in Hong Kong.
                A total of 120 women with certain gestational age, determined by early pregnancy ultrasound scan, were recruited from 1st July, 1998 to 31st December, 1999. Sixty women were randomly allocated to sweeping of membranes and the other 60 women acted as control. The satisfaction for women allocated to sweeping of membranes was assessed by a questionnaire after the procedure. The two groups were assessed on intention-to-treat basis.
                The incidence of formal induction of labour was compared between the two groups. Possible complications of sweeping of membranes such as rupture of membranes, intrapartum infection, postpartum infection, and neonatal infection were also assessed. Maternal and perinatal outcomes were also assessed.
                The recruitment to delivery interval was significantly shorter among women who had sweeping of membranes (3.2 versus 4.2 days, P < 0.05). The incidence of induction of labour was comparable (35.5% versus 38%, RR 0.91, 95% CI 0.57 - 1.46). The incidences of caesarean section and assisted vaginal delivery were comparable. The incidences of premature rupture of membranes, intrapartum, and postpartum infection were comparable. The perinatal outcomes were also comparable between the two groups. Up to 70% of women found that this procedure was associated with significant discomfort. One third of these women complained of significant pain.
                Sweeping of membranes beyond 40 weeks does not reduce the need for formal induction of labour at 42 weeks. Although it is safe, the majority of women felt uncomfortable during the procedure. To determine whether sweeping the membranes in pregnancies of longer than 40 weeks gestation results in an accelerated onset of labour and a reduction in the incidence of induction of labour.
                A prospective randomised controlled study.
                The antenatal clinic of a district general hospital.
                One hundred and ninety-five antenatal women with pregnancies proceeding beyond 40 weeks gestation.
                A Bishop score assessment of the cervix alone or combined with a membrane sweep, on a randomised basis.
                Subsequent duration of pregnancy to the onset of spontaneous labour. The incidence of induction of labour for post-maturity.
                Sweeping the membranes significantly reduces the subsequent duration of pregnancy, from an average of five days to two days following the procedure. The proportion of inductions of labour was 8.1% in the swept group and 18.8% in the control group. No harmful side effects to the procedure were noted.
                Sweeping the membranes is a safe and useful procedure which results in a reduced incidence of post-mature pregnancies, and a subsequent reduction in the labour induction rate. To determine whether sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy.
                Randomized controlled trial.
                A district maternity hospital.
                65 women attending an antenatal clinic; 33 randomized to sweeping of the membranes and 32 to a control group.
                Proportion of women achieving spontaneous labour.
                Spontaneous labour occurred more often in the sweeping of the membranes group than in the control group (25/33 (76%) vs 12/32 (38%); odds ratio (OR) 4.65; 95% confidence interval (CI) 1.75 to 12.31; P = 0.002). In addition a greater proportion of women in the sweeping group had a cervical dilatation of 4 cm or more at the first vaginal examination in the labour ward (16/33 (49%) vs 5/32 (16%); OR 4.39; 95% CI 1.56 to 12.32; P = 0.005). There were fewer maternal infections in the sweeping group (0/33 vs 4/32 (12%); OR 0.12; 95% CI 0.02 to 0.88; P = 0.04). There were no differences in the type of analgesia used in labour, the mode of delivery or neonatal outcome.
                Sweeping of the membranes is an effective method of induction of labour in women with prolonged pregnancy. 1. To evaluate the effectiveness of sweeping of the membranes to reduce the need for a formal induction of labour; 2. to evaluate the side effects of this intervention.
                A randomised controlled clinical trial.
                Three tertiary care hospitals of the province of Quebec, Canada.
                Two hundred women for whom non-urgent induction of labour was medically indicated.
                Women were randomly allocated to sweeping of membranes, or vaginal examination for Bishop scoring only.
                1. Cumulative incidence and relative risk of induction of labour by either oxytocin, prostaglandins or amniotomy; 2. women's discomfort and side effects attributable to sweeping of the membranes.
                Women allocated to sweeping of the membranes required formal induction of labour less frequently than women in the control group, but this difference was not statistically significant (49% vs 60%, RR 0.83, 95% CI 0.64-1.07). Pain during vaginal examination and other side effects were more frequently reported by women allocated to the sweeping group.
                The observed reduction in the need for formal induction of labour is smaller than in previous studies. Side effects and discomfort associated with sweeping of the membranes must be taken into account when counselling women who require induction of labour. The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies. We randomly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days. Our patients were divided into three groups. Group A consisted of 34 women who were subjected to sweeping of the membranes. Uterine stimulation with oxytocin was applied in 35 women (group B), and 35 women (group C) were used as a control group. We had no significant reduction of the time interval from sweeping of the membranes until delivery (1.9 +/- 1.2 days), compared to that of group B (2.1 +/- 0.8 days) as well as that of the control group (2.5 +/- 0.9 days). The incidence of spontaneous labor in patients after sweeping of the membranes was greater (67.6%) when compared with oxytocin-stimulated patients and the control group (p < 0.05). Furthermore, a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups, but sweeping of the membranes significantly decreased the incidence of postterm pregnancies (p < 0. 05). We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks, thus reducing the need for induction.
                Copyright 2000 S. Karger AG, Basel A prospective, randomized controlled trial was undertaken at the Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn Hospital to determine whether stripping of the fetal membranes is a safe and effective method for induction of labor in uncomplicated term pregnancy. Ninety-six women were included in this study; 16 were excluded; 41 were randomized to a study group and 39 to a control group. Both groups had pelvic examination performed under sterile technique and a Bishop score was assessed. In the study group, membrane stripping was performed. Gentle pelvic examination for Bishop scoring was continued weekly in both groups. Thirty five of 41 women (85.4%) in the study group delivered within 7 days as compared to 22 of 39 women (56.4%) in the control group, a statistically significant difference (P = 0.004). A statistically significant difference was also observed with respect to the mean number of days to delivery (5.3 +/- 4.9 versus 9.5 +/- 5.9 days, respectively; P = 0.002). No statistically significant differences were observed in both maternal and fetal complications. In conclusion, membrane stripping is a safe and effective method for induction of labor in uncomplicated term pregnancy. To evaluate weekly stripping of membranes at term to determine its safety and effectiveness in reducing the incidence of prolonged and postterm pregnancies.
                One hundred forty-two pregnant women with certain gestational dates were randomly selected to receive, starting at 38 weeks, either weekly stripping of membranes (73 patients) or weekly gentle cervical examinations (69 patients).
                Women who received stripping had earlier delivery (8.2 versus 12.2 days; P < .005) and less incidence of delivery at 41 weeks or greater (three versus 13 patients; P < .01). The reduction remained consistent for favorable and unfavorable Bishop scores, and for nulliparas and multiparas. Only three subjects in the study delivered at 42 weeks or greater. No woman reported rupture of membranes after stripping.
                Stripping of membranes is a safe method to reduce the incidence of prolonged pregnancies and the length of term gestations. Larger trials on populations with a higher incidence of postterm pregnancies are needed to evaluate its efficacy in reducing the incidence of postterm pregnancies. Our purpose was to determine whether the risk for postdatism can be reduced by serial membrane sweeping in women with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result.
                Women with uncomplicated pregnancies, who were candidates for a vaginal delivery with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result were asked to participate in this investigation. Patients were chosen at random and assigned to a group for membrane sweeping every 3 days or to a control group who received gentle examinations every 3 days.
                Sixty-five women were selected at random for serial membrane sweeping (n = 33) or for the control group (n = 32). Although gestational age and Bishop score at study entry were similar, the gestational age on admission for delivery was earlier in the membrane sweeping group (39.9 +/- 0.3) versus the control group (41.5 +/- 0.6, P < .0001). The Bishop score on admission to labor and delivery was greater (8.8 +/- 2.1) in the membrane sweeping group than in the control group (6.2 +/- 2.7, P < .0001). The number of women admitted for labor inductions at 42 weeks' gestation was 18 of 32 (56%) in the control group versus none (0 of 24) in the membrane-sweeping group (P < .0001).
                Women with an unfavorable cervix at 39 weeks' gestation and a negative fetal fibronectin test result are at risk for not being delivered by 41 completed weeks and thus may require postdates induction or antenatal testing. Serial membrane sweeping significantly reduces the risk of postdatism and induction of labor. Membrane stripping has been used clinically for many years but has not been well studied. An investigation was undertaken to determine whether weekly membrane stripping beginning at 38 weeks could safely reduce post-term pregnancies. One hundred eighty patients with firm gestational dates were randomized to either a treatment or control group. Control subjects received a gentle cervicovaginal examination each week to assess Bishop scores, whereas the treatment group also underwent weekly stripping of membranes. Women who received treatment had earlier delivery (mean +/- SEM 8.60 +/- 0.74 versus 15.14 +/- 0.83 days; P less than .0001) and fewer post-term deliveries than those in the control group (three versus 14; P less than .004). The reduction of post-term pregnancies was most notable in nulliparous women with unfavorable Bishop scores. Complications were similar in both groups. Membrane stripping was safe and was associated with earlier delivery and a decreased incidence of post-term gestation. To assess the efficacy of stripping of membranes in initiation of labor and to study its effect on maternal and perinatal morbidity.
                One-hundred primigravidae with certain gestational dates were randomized at 38 weeks gestation to either receive stripping of membranes or only gentle cervical examination. Cervical swabs were taken before pelvic examination at 38 weeks and again at the onset of labor. Placental membranes were sent for bacteriological study after delivery in all patients.
                The mean gestational age, parity and Bishop score were similar in both groups at recruitment. Gestational age at delivery was lower in the study group (38.70 +/- 0.63) compared to the control group. Seventy-two percent of the study group and 8% of the control group had spontaneous onset of labor within 7 days of examination. Labor was induced in one patient (2%) of the study group and 16 patients (32%) of the control group. No statistically significant difference was noted in incidence of premature rupture of membranes (PROM), mode of delivery, intrapartum events and perinatal outcome. No increase in neonatal morbidity was seen in association with this procedure. No patient in the study group had clinical evidence of chorioamnionitis. There was no statistically significant difference in the microbiological flora of both groups.
                Stripping of the fetal membranes is a safe and efficacious procedure for induction of labor. It decreases the incidence of induction of labor with no increase in incidence of maternal and neonatal morbidity. To determine the best method of cervical ripening to prevent postdate inductions in women with an unfavorable cervix at 41 weeks' gestation.
                Women presenting at 41 weeks' gestation with a Bishop score of < or = 4 received daily dinoprostone (Cervidil) vaginal inserts (group I) or daily membrane sweeping (group II).
                One-hundred and eighty-two women were prospectively randomized with 91 women in each arm. The women in group II, membrane sweeping, had Bishop scores significantly greater on admission for delivery (p < 0.001), had less time elapsed from admission to delivery (p = 0.018), and had fewer labor inductions at 42 weeks (p = 0.04) than the women in group I, the dinoprostone group. In addition, a greater number of women in group II were admitted in spontaneous labor (p = 0.006) than in group I. Total antenatal costs for the membrane sweeping group was $15,120 versus $59,540 for the dinoprostone group.
                Daily membrane sweeping was more effective than dinoprostone administration with fewer postdate inductions at one-fourth the cost. To determine the effectiveness of membrane stripping at term to promote the onset of labor.
                One hundred twenty gravidas at 38 weeks' gestation, who were attending an antenatal clinic and planned to deliver at Maharaj Nakorn Chiang Mai University Hospital in northern Thailand, were assigned randomly to one of two groups. One group had weekly pelvic examinations only, and the other also had membrane stripping, beginning at 38 weeks' gestation and continuing until the onset of labor or until 42 completed weeks' gestation. Outcome measures included the proportion of patients who delivered with 7 days after the first examination, Bishop scores among those who did not deliver, days from the first examination to delivery, incidence of postterm pregnancy, and maternal and fetal complication.
                Twenty-five of 61 patients (41%) assigned to membrane stripping delivered within 1 week, compared with 12 of 59 controls (20.3%), a statistically significant difference (P = .014). There was also a statistically significant difference (P = .013, Mann-Whitney U test) in the Bishop scores among those who did not deliver within 1 week (4 +/- 2.5 versus 2.6 +/- 1.7 in the study and control groups, respectively). A significant difference was also observed with respect to the mean number of days to delivery (8.8 +/- 6.7 versus 13.6 +/- 7.5, respectively; P < .001). The incidence of postterm pregnancy was one of 61 (1.6%) and three of 59 (5.1%) in the stripping and control groups, respectively. No significant differences were observed in maternal and fetal complications.
                Membrane stripping is safe and effective in promoting the onset of labor at term. This study was carried out to evaluate the efficacy and safety of membrane stripping at term in reducing the incidence of post-term (41 weeks or greater) pregnancies. One hundred and thirty-seven pregnant women at 38 weeks gestation were randomised to receive either membrane stripping (69) or gentle cervical examination (68). Women who received stripping had earlier delivery (4.8 vs. 12.1 days; P<0.001) and less incidence of delivery at 41 weeks or greater (3% vs. 16%; P=0.009). No statistically significant difference was noted in incidence of premature rupture of membranes, clinical evidence of chorioamnionitis, intrapartum characteristics and perinatal outcome. We conclude that membrane stripping is a safe method to reduce the incidence of post-term pregnancy. A group of 91 pregnant women at term were studied randomly to see the effect of digital stripping of the membranes from the lower uterine segment upon the onset of labor. The women with unfavorable cervices (Bishop score 0 to 5) demonstrated a significant increase in the onset of labor within 48 hours as compared to controls. When the cervix was favorable (Bishop score 6 to 10), there was no significant effect. The overall success rate for induction of labor was not significantly altered (43.5% in membrane-stripped patients, 22.2% in controls). There were no major complications of the procedure. Our purpose was to determine the optimal management of pregnancies beyond 41 weeks' gestation with a cervix unfavorable for induction.
                All uncomplicated pregnancies that reached 41 weeks' gestation with a Bishop score of < or = 4 were randomly assigned to one of three groups: (1) daily cervical examinations, (2) daily membrane stripping, or (3) daily placement of prostaglandin gel until 42 weeks.
                In 105 pregnancies the Bishop score on admission to labor and delivery was significantly greater in the groups receiving prostaglandin or stripping of the membranes versus the control group, whereas the converse was time of gestational age at delivery (p = 0.0001). Fewer patients required induction in the two treatment groups (20%, 17%) versus the control (69%) patients (p < 0.0001).
                Daily membrane stripping or daily placement of prostaglandin gel is successful in reducing the number of inductions at 42 weeks for postdatism. To determine whether routine antepartum stretching of the cervix and stripping of the membranes at term would shorten the length of pregnancies, and whether this correlated with cervical status and fetal and maternal parameters.
                A prospective, randomised, controlled study of 293 term gravidas, free of medical complications, divided into two groups: stretching/stripping, and non-stretching/stripping. Digital separation of the fetal membranes from the lower uterine segment, and cervical stretching, were performed during routine vaginal examination of the first group. In the second group, only routine vaginal examination was performed.
                Of 293 patients, 152 underwent a trial of stretching and stripping; 141 served as a control group. The mean interval (hours to delivery after the procedure) was 136 h (S.D. 10), compared to 161 h (S.D. 11) in the control group (P = 0.095; not significant), but with only a trend towards the shorter interval in the first group. When patients were matched according to weeks of gestation and fetal and maternal parameters, only those at 41 weeks' gestation or more had a significant reduction in the interval from the procedure to delivery (mean 91 h (S.D. 8) compared to mean 125 h (S.D. 10) in the control group; P < 0.007). This observation was independent of cervical status and other maternal or fetal parameters.
                Only patients > or = 41 weeks' gestation benefitted from stretching of the cervix and stripping of the fetal membranes. The effect was not dependent on the cervical status or other maternal and fetal parameters. Our objective was to compare maternal and perinatal outcomes between two management schemes for women with preterm premature rupture of the membranes and documented fetal pulmonary maturity.
                Of 164 women with preterm premature rupture of the membranes at 32 weeks to 36 weeks 6 days' gestation, 93 eligible and consenting women were randomly selected for either induction of labor (n = 46) or expectant management (n = 47). Expectant management included hospitalization, assessment for fetal heart rate abnormalities, chorioamnionitis, and labor. Digital cervical examinations were prohibited until progressive labor occurred. Follow-up was also done for the 71 women who did not participate.
                The women in the induction of labor and expectant management groups had similar demographic characteristics and gestational ages (34.1 vs 34.3 weeks). Expectant management was associated with prolonged latencies to labor, delivery, and maternal hospitalization (p < 0.001), as well as increased hospitalization of infants at 2 to 5 days after delivery (p < 0.05). These patients had increased chorioamnionitis and fetal heart rate abnormalities before labor (p = 0.01, 0.03). Infants received more frequent (p < 0.001) and prolonged antimicrobial therapy after expectant management (p = 0.003) with no reduction in proven sepsis (6.8% vs 4.4%). These latter differences were influenced by the neonatologist's concern over potential neonatal infection.
                Among women with preterm premature rupture of the membranes at 32 to 36 weeks with mature surfactant profiles, immediate induction of labor reduces the duration of hospitalization and infection in both mothers and neonates. A prospective, randomized investigation was undertaken in a low-risk group of pregnant women at term (38-42 weeks' gestation) to determine if stripping the fetal membranes would safely result in earlier delivery. Ninety-nine patients entered the study; 51 underwent stripping of the membranes, and 48 controls did not. Fifty-nine percent of the patients in the stripped group delivered within one week as compared to 21% in the nonstripped group (P less than .0003). Two pregnancies in the stripped group advanced beyond 42 weeks' gestation as compared to six pregnancies in the control group (P = .12). A single gravida in the control group developed chorioamnionitis during labor. There were no other infections or other complications. Stripping the membranes was associated with earlier delivery and was not associated with any complications.
Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects. 
[Note: The 11 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]