Li Yao, Yin Jin-Zhu, Pang Wan-Ying, Zhang Liu, Wei Lin-Na
Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, No. 120, Dalongshan Road, Yubei District, Chongqing, China.
The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, Guangzhou, China.
BMC Pregnancy Childbirth. 2025 Sep 24;25(1):940. doi: 10.1186/s12884-025-08098-7.
Membrane sweeping is recommended to facilitate spontaneous labor, reduce the need for formal induction, and prevent post-term pregnancy. However, its overall effects on maternal and neonatal outcomes remain unclear. This study aims to evaluate the impact of membrane sweeping in term pregnancy on maternal and neonatal outcomes.
The initial search was conducted through December 19, 2023, and an updated search extended the inclusion of publications to July 15, 2025. Study selection and data extraction were done independently by two researchers. The Cochrane risk of bias 2.0 tool was used to evaluate study quality. Data analysis was performed using R 4.5.0, calculating mean differences with 95% confidence intervals (CIs) for continuous outcomes and relative risk (RR) for dichotomous outcomes. Subgroup analyses were conducted based on the timing and frequency of membrane sweeping. Meta-regression was applied to identify factors influencing results, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to evaluate evidence certainty.
Thirty-four randomized controlled trials involving 6355 pregnant women were included. Meta-analyses indicated that membrane sweeping significantly promoted spontaneous labor (RR = 1.28, 95% CI: 1.16, 1.41, I = 82.6%) and reduced formal induction of labor (RR = 0.66, 95% CI: 0.51, 0.85, I = 79.5%). Membrane sweeping at 40 weeks to 40 weeks and 6 days significantly increased the spontaneous delivery and reduced induction. Single membrane sweeping significantly improved spontaneous labor and reduced induction. Compared with routine care, membrane sweeping may prevent post-term pregnancy, increase vaginal delivery rates, reduce cesarean sections, and shorten the delivery interval. No significant differences were found in premature rupture of membranes, intrapartum fever, postpartum fever, or meconium-stained liquor. For neonatal outcomes, meta-analysis showed that membrane sweeping significantly reduced neonatal intensive care unit admission rates, whereas no difference in neonatal infection rates was observed. Limited evidence indicated significantly lower proportions of 1- and 5-minute Apgar scores < 7 in the membrane-sweeping group.
Our findings suggest that membrane sweeping may be an effective and relatively safe method for labor induction. Given the low certainty of the evidence, high-quality randomized controlled trials are urgently needed to corroborate these exploratory findings.
CRD42023494189 (PROSPERO).
推荐进行人工破膜以促进自然分娩，减少正规引产的需求，并预防过期妊娠。然而，其对母婴结局的总体影响仍不明确。本研究旨在评估足月妊娠时人工破膜对母婴结局的影响。
最初的检索截至2023年12月19日，更新后的检索将纳入的出版物范围扩展至2025年7月15日。两名研究人员独立进行研究筛选和数据提取。使用Cochrane偏倚风险2.0工具评估研究质量。使用R 4.5.0进行数据分析，计算连续结局的平均差异及95%置信区间（CI），二分结局的相对风险（RR）。根据人工破膜的时间和频率进行亚组分析。应用Meta回归确定影响结果的因素，并使用推荐分级、评估、制定与评价方法评估证据的确定性。
纳入了34项涉及6355名孕妇的随机对照试验。Meta分析表明，人工破膜显著促进自然分娩（RR = 1.28，95%CI：1.16，1.41，I² = 82.6%）并减少正规引产（RR = 0.66，95%CI：0.51，0.85，I² = 79.5%）。在40周零天至40周零6天进行人工破膜显著增加了自然分娩率并减少了引产。单次人工破膜显著改善了自然分娩并减少了引产。与常规护理相比，人工破膜可能预防过期妊娠，提高阴道分娩率，减少剖宫产，并缩短分娩间隔。在胎膜早破、产时发热、产后发热或羊水粪染方面未发现显著差异。对于新生儿结局，Meta分析表明人工破膜显著降低了新生儿重症监护病房入住率，而在新生儿感染率方面未观察到差异。有限的证据表明，人工破膜组1分钟和5分钟阿氏评分<7的比例显著较低。
我们的研究结果表明，人工破膜可能是一种有效且相对安全的引产方法。鉴于证据的确定性较低，迫切需要高质量的随机对照试验来证实这些探索性发现。
CRD42023494189（PROSPERO）
