Level 1: Likely reliable evidence

Membrane sweeping, or membrane stripping, is commonly used at term to hasten the onset of labor. The maneuver involves intentional digital separation of chorionic membranes from the lower uterine segment with a gloved finger. This technique may be used alone or in addition to labor induction. In a recent study, 274 women at term with a singleton fetus and intact membranes were randomized to membrane sweeping vs. no membrane sweeping at the initiation of formal labor induction with dinoprostone pessary or amniotomy (Obstet Gynecol. 2006;107:569-577). No additional membrane sweeping was provided during labor progression.The analysis included 264 women (10 were excluded due to ineligibility).

Membrane sweeping (vs. no membrane sweeping) was associated with an increased rate of spontaneous vaginal delivery (69% vs. 56%, P = 0.04, NNT 8), decreased mean time to delivery (14 vs. 19 hours, P = 0.003), and decreased oxytocin use (46% vs. 59%, P = 0.04, NNT 8). In addition, the mean score (from 0-10; lower scores were more favorable) for maternal satisfaction with the birth process favored membrane sweeping (4 vs. 4.7, P = 0.015). The mean score (from 0-10) for pain at the initiation of labor favored no membrane sweeping (4.7 vs. 3.5, P <0.001). Outcomes not statistically significant were rates of instrumental vaginal delivery and rates of cesarean delivery.

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