Finucane Elaine M, Murphy Deirdre J, Biesty Linda M, Gyte Gillian Ml, Cotter Amanda M, Ryan Ethel M, Boulvain Michel, Devane Declan
University Maternity Hospital Limerick, Ennis Road, Limerick, Ireland.
University of Dublin, Department of Obstetrics and Gynaecology Trinity College, Coombe Women's Hospital, Dolphin's Barn, Dublin 8, Ireland.
Cochrane Database Syst Rev. 2020 Feb 27;2(2):CD000451. doi: 10.1002/14651858.CD000451.pub3.
Induction of labour involves stimulating uterine contractions artificially to promote the onset of labour. There are several pharmacological, surgical and mechanical methods used to induce labour. Membrane sweeping is a mechanical technique whereby a clinician inserts one or two fingers into the cervix and using a continuous circular sweeping motion detaches the inferior pole of the membranes from the lower uterine segment. This produces hormones that encourage effacement and dilatation potentially promoting labour. This review is an update to a review first published in 2005.
To assess the effects and safety of membrane sweeping for induction of labour in women at or near term (≥ 36 weeks' gestation).
We searched Cochrane Pregnancy and Childbirth's Trials Register (25 February 2019), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (25 February 2019), and reference lists of retrieved studies.
Randomised and quasi-randomised controlled trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed on a predefined list of labour induction methods. Cluster-randomised trials were eligible, but none were identified.
Two review authors independently assessed studies for inclusion, risk of bias and extracted data. Data were checked for accuracy. Disagreements were resolved by discussion, or by including a third review author. The certainty of the evidence was assessed using the GRADE approach.
We included 44 studies (20 new to this update), reporting data for 6940 women and their infants. We used random-effects throughout. Overall, the risk of bias was assessed as low or unclear risk in most domains across studies. Evidence certainty, assessed using GRADE, was found to be generally low, mainly due to study design, inconsistency and imprecision. Six studies (n = 1284) compared membrane sweeping with more than one intervention and were thus included in more than one comparison. No trials reported on the outcomes uterine hyperstimulation with/without fetal heart rate (FHR) change, uterine rupture or neonatal encephalopathy. Forty studies (6548 participants) compared membrane sweeping with no treatment/sham Women randomised to membrane sweeping may be more likely to experience: · spontaneous onset of labour (average risk ratio (aRR) 1.21, 95% confidence interval (CI) 1.08 to 1.34, 17 studies, 3170 participants, low-certainty evidence). but less likely to experience: · induction (aRR 0.73, 95% CI 0.56 to 0.94, 16 studies, 3224 participants, low-certainty evidence); There may be little to no difference between groups for: · caesareans (aRR 0.94, 95% CI 0.85 to 1.04, 32 studies, 5499 participants, moderate-certainty evidence); · spontaneous vaginal birth (aRR 1.03, 95% CI 0.99 to 1.07, 26 studies, 4538 participants, moderate-certainty evidence); · maternal death or serious morbidity (aRR 0.83, 95% CI 0.57 to 1.20, 17 studies, 2749 participants, low-certainty evidence); · neonatal perinatal death or serious morbidity (aRR 0.83, 95% CI 0.59 to 1.17, 18 studies, 3696 participants, low-certainty evidence). Four studies reported data for 480 women comparing membrane sweeping with vaginal/intracervical prostaglandins There may be little to no difference between groups for the outcomes: · spontaneous onset of labour (aRR, 1.24, 95% CI 0.98 to 1.57, 3 studies, 339 participants, low-certainty evidence); · induction (aRR 0.90, 95% CI 0.56 to 1.45, 2 studies, 157 participants, low-certainty evidence); · caesarean (aRR 0.69, 95% CI 0.44 to 1.09, 3 studies, 339 participants, low-certainty evidence); · spontaneous vaginal birth (aRR 1.12, 95% CI 0.95 to 1.32, 2 studies, 252 participants, low-certainty evidence); · maternal death or serious morbidity (aRR 0.93, 95% CI 0.27 to 3.21, 1 study, 87 participants, low-certainty evidence); · neonatal perinatal death or serious morbidity (aRR 0.40, 95% CI 0.12 to 1.33, 2 studies, 269 participants, low-certainty evidence). One study, reported data for 104 women, comparing membrane sweeping with intravenous oxytocin +/- amniotomy There may be little to no difference between groups for: · spontaneous onset of labour (aRR 1.32, 95% CI 88 to 1.96, 1 study, 69 participants, low-certainty evidence); · induction (aRR 0.51, 95% CI 0.05 to 5.42, 1 study, 69 participants, low-certainty evidence); · caesarean (aRR 0.69, 95% CI 0.12 to 3.85, 1 study, 69 participants, low-certainty evidence); · maternal death or serious morbidity was reported on, but there were no events. Two studies providing data for 160 women compared membrane sweeping with vaginal/oral misoprostol There may be little to no difference between groups for: · caesareans (RR 0.82, 95% CI 0.31 to 2.17, 1 study, 96 participants, low-certainty evidence). One study providing data for 355 women which compared once weekly membrane sweep with twice-weekly membrane sweep and a sham procedure There may be little to no difference between groups for: · induction (RR 1.19, 95% CI 0.76 to 1.85, 1 study, 234 participants, low-certainty); · caesareans (RR 0.93, 95% CI 0.60 to 1.46, 1 study, 234 participants, low-certainty evidence); · spontaneous vaginal birth (RR 1.00, 95% CI 0.86 to 1.17, 1 study, 234 participants, moderate-certainty evidence); · maternal death or serious maternal morbidity (RR 0.78, 95% CI 0.30 to 2.02, 1 study, 234 participants, low-certainty evidence); · neonatal death or serious neonatal perinatal morbidity (RR 2.00, 95% CI 0.18 to 21.76, 1 study, 234 participants, low-certainty evidence); We found no studies that compared membrane sweeping with amniotomy only or mechanical methods. Three studies, providing data for 675 women, reported that women indicated favourably on their experience of membrane sweeping with one study reporting that 88% (n = 312) of women questioned in the postnatal period would choose membrane sweeping in the next pregnancy. Two studies reporting data for 290 women reported that membrane sweeping is more cost-effective than using prostaglandins, although more research should be undertaken in this area.
AUTHORS' CONCLUSIONS: 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.
引产是指人为刺激子宫收缩以促进分娩发动。引产有多种药理、手术和机械方法。胎膜剥离术是一种机械技术，临床医生将一根或两根手指插入宫颈，通过持续的圆周扫动动作，将胎膜的下缘从子宫下段分离。这会产生促进宫颈消退和扩张的激素，从而可能促进分娩。本综述是对2005年首次发表的一篇综述的更新。
评估胎膜剥离术对足月或近足月（≥36周妊娠）妇女引产的效果和安全性。
我们检索了Cochrane妊娠与分娩试验注册库（2019年2月25日）、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台（ICTRP）（2019年2月25日）以及检索到的研究的参考文献列表。
随机和半随机对照试验，比较用于孕晚期宫颈成熟或引产的胎膜剥离术与安慰剂/不治疗或预定义引产方法列表中的其他方法。整群随机试验符合条件，但未检索到。
两位综述作者独立评估研究是否纳入、偏倚风险并提取数据。检查数据的准确性。分歧通过讨论解决，或纳入第三位综述作者解决。使用GRADE方法评估证据的确定性。
我们纳入了44项研究（本次更新新增20项），报告了6940名妇女及其婴儿的数据。我们自始至终使用随机效应模型。总体而言，在大多数研究领域，偏倚风险被评估为低或不明确。使用GRADE评估的证据确定性普遍较低，主要是由于研究设计、不一致性和不精确性。六项研究（n = 1284）比较了胎膜剥离术与多种干预措施，因此被纳入多个比较。没有试验报告子宫过度刺激伴/不伴胎心率（FHR）变化、子宫破裂或新生儿脑病的结局。40项研究（6548名参与者）比较了胎膜剥离术与不治疗/假手术。随机接受胎膜剥离术的妇女可能更有可能经历：·自然发动分娩（平均风险比（aRR）1.21，95%置信区间（CI）1.08至1.34，17项研究，3170名参与者，低确定性证据）。但不太可能经历：·引产（aRR 0.73，95%CI 0.56至0.94，16项研究，3224名参与者，低确定性证据）；两组之间在以下方面可能几乎没有差异：·剖宫产（aRR 0.94，95%CI 0.85至1.04，32项研究，5499名参与者，中等确定性证据）；·自然阴道分娩（aRR 1.03，95%CI 0.99至1.07，26项研究，4538名参与者，中等确定性证据）；·产妇死亡或严重发病（aRR 0.83，95%CI 0.57至1.20，17项研究，2749名参与者，低确定性证据）；·新生儿围产期死亡或严重发病（aRR 0.83，95%CI 0.59至1.17，18项研究，3696名参与者，低确定性证据）。四项研究报告了480名妇女比较胎膜剥离术与阴道/宫颈内前列腺素的数据。两组在以下结局方面可能几乎没有差异：·自然发动分娩（aRR 1.24，95%CI 0.98至1.57，3项研究，339名参与者，低确定性证据）；·引产（aRR 0.90，95%CI 0.56至1.
