http://womens- health.jwatch. org/cgi/content/ full/2008/
710/1?q=etoc_ jwwomenbe

No Need to Sweep
Whether or not women underwent membrane sweeping, overall rates of
induction, postmaturity, and prelabor membrane rupture were similar.

Membrane sweeping to move the membranes off the lower pole of the uterus,
routine in obstetric care, is performed to decrease the likelihood of
labor
induction or postmature delivery (JW Apr 11 2006). However, concerns about
premature rupture of membranes and infection have led to debate about the
merits of this practice. Investigators randomized 300 women to undergo
membrane sweeping at 38 weeks' gestation (with subsequent weekly sweeping)
or no membrane sweeping. Participants had singleton pregnancies with
cephalic presentation and anticipated vaginal delivery; women were
excluded
if they had indications for labor induction or cesarean delivery or had
contraindications for membrane sweeping. Participants and researchers were
blinded to group allocation with the understanding that this would not
constitute full blinding, as patients probably would become aware of their
assigned interventions.

Intention-to- treat analysis showed no significant between-group
difference
in occurrence of prelabor rupture of membranes (7% of women without
sweeping
vs. 12% of women with sweeping; P=0.19). Among women with cervical
dilation
1 cm, however, 9% in the sweep group had prelabor membrane rupture
versus no
patients in the no-sweep group (P<0.05). Other obstetric outcomes,
including
cesarean delivery, spontaneous labor, induction, or postmaturity, occurred
at similar rates in the two groups.

Comment: These data indicate neither great value nor great risk from
membrane sweeping starting at 38 weeks. However, subgroup analysis showed
that women with cervical dilation 1 cm during late pregnancy could be at
risk for prelabor membrane rupture in association with sweeping,
suggesting
that such women might be more sensitive to the procedure. This study
excluded women with multiple gestations or those with various obstetric
indications. Despite these limitations, the data suggest that there is no
need to sweep.

- Sandra Ann Carson, MD
Published in Journal Watch Women's Health July 10, 2008