However, in the context of labour induction at term this is unlikely. It is possible for one intervention to cause more deaths but less severe morbidity. This is not an ideal solution because some components are clearly less severe than others. Perinatal and maternal morbidity and mortality are composite outcomes. uterine rupture, admission to intensive care unit, septicaemia). (5) serious maternal morbidity or death (e.g. seizures, birth asphyxia defined by trialists, neonatal encephalopathy, disability in childhood) (4) serious neonatal morbidity or perinatal death (e.g. (2) uterine hyperstimulation with fetal heart rate (FHR) changes (1) vaginal delivery not achieved within 24 hours Subgroup analyses were limited to the primary outcomes: Differences were settled by discussion.įive primary outcomes were chosen as being most representative of the clinically important measures of effectiveness and complications. All these interventions were considered together in this review.Ĭlinically relevant outcomes for trials of methods of cervical ripening/labour induction have been prespecified by the authors of the labour induction generic protocol ( Hofmeyr 2000). When the cervix is closed, some perform a cervical massage to stimulate the production of prostaglandins ( El‐Torkey 1992). When the membranes cannot be reached, some clinicians attempt to stretch the cervix until sweeping is feasible ( Goldenberg 1996). Increased local production of prostaglandins, which have been documented following this procedure, provide a plausible mechanism for a potential effect of this intervention on pregnancy duration ( Keirse 1983). Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. The technique is relatively simple: during vaginal examination, the clinician's finger is introduced into the cervical os.
This intervention is currently performed by a large number of clinicians. The goal of sweeping of the membranes is to initiate labour through a cascade of physiological events, and thus to reduce pregnancy duration or to pre‐empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. In this review we will use the word 'sweeping' instead of 'stripping', but both words describe the same intervention. Stripping/sweeping of the membranes is an old method for inducing labour ( Hamilton 1810). The generic protocol describes how a number of standardised reviews will be combined to compare various methods of preparing the cervix of the uterus and inducing labour.
For more detailed information on the rationale for this methodological approach, please refer to the currently published 'generic' protocol ( Hofmeyr 2000).
#CRAMPING AFTER MEMBRANE SWEEP SERIES#
This review is one of a series of reviews of methods of labour induction using a standardised protocol. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. There was no evidence of a difference in the risk of maternal or neonatal infection. To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Twenty‐two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison).
0 kommentar(er)
