Membrane Sweeping and its Impact on Labor and Delivery: A Systematic Review Analysis
A recent systematic review and meta-analysis, published in BMC Pregnancy and Childbirth, investigated the effectiveness of membrane sweeping in term pregnancy for promoting spontaneous labor and preventing post-term pregnancy. The analysis synthesized data from numerous studies to evaluate the procedure’s impact on various maternal and neonatal outcomes.
The review encompassed twenty-seven studies evaluating vaginal delivery rates.Results demonstrated a statistically significant improvement with membrane sweeping (RR = 1.07, 95% CI: [1.03,1.11], P* = 0.0008). Correspondingly, the analysis of these same twenty-seven studies revealed a lower rate of cesarean section in the membrane sweeping group compared to routine care (RR = 0.81, 95% CI: [0.70, 0.95], *P = 0.008). However, no significant difference was observed in the incidence of instrumental delivery between the two groups (RR = 1.04,95% CI: [0.89, 1.22], P* = 0.63).
further analysis of seven studies focused on the time interval between membrane sweeping and delivery. The pooled results indicated a significant shortening of this interval following the procedure (MD = -4.51, 95% CI: [-6.86,-2.16], *P = 0.0002).
regarding maternal safety, the review of nineteen studies involving 3954 women found no significant difference in the incidence of pre-labor rupture of membranes between those undergoing membrane sweeping and those receiving routine care. Similarly, no statistically significant differences were identified in the rates of intrapartum or postpartum fever. An analysis of eight studies also showed no significant difference in the incidence of meconium-stained liquor.
The analysis also examined neonatal outcomes. the proportion of one-minute/five-minute apgar scores less than 7 was substantially lower in the membrane sweeping group. Thirteen studies evaluating neonatal intensive Care Unit (NICU) admission rates showed a lower rate of admission in the membrane sweeping group (RR = 0.70, 95% CI: [0.51,0.95], *P* = 0.02). Though, six studies assessing neonatal infection rates found no statistically significant difference between the groups.
The researchers assessed potential publication bias using funnel plots and Egger’s test, with results detailed in Supplementary Table 4. The quality of evidence for each outcome was assessed using the GRADE approach by two autonomous reviewers, categorized as ‘high’, ‘moderate’, ‘low’, or ‘very low’ based on consensus, and summarized in Supplementary Table 5.