Membrane sweeping in patients planning a trial of labor after cesarean: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Membrane sweeping has been shown to reduce time to the onset of labor in women at term but the effects of membrane sweeping in women with a prior cesarean delivery are largely unknown.Objective: To determine the effects of membrane sweeping on promoting labor in patients undergoing a trial of labor after cesarean.Study design: Searches were performed in Medline, Ovid, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials using a combination of keywords related to "membrane sweeping," "membrane stripping," "vaginal birth after cesarean," and "trial of labor after cesarean" from inception of databases until April 2018. Study eligibility criteria: We included all randomized controlled trials (RCTs) of singleton or twin gestations at 36 weeks or greater that evaluated prophylactic or prelabor membrane sweeping in patients undergoing a trial of labor after cesarean. Exclusion criteria were trials that did not include patients with a prior uterine scar or cesarean delivery, or that were studies of membrane sweeping during initiation of induction of labor. Study appraisal and synthesis methods: the primary outcome was the rate of spontaneous labor. Meta-analysis was performed using the random-effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI).Results: Two studies met inclusion criteria and were included in our meta-analysis (n = 361). Membrane sweeping did not have an effect on the onset of labor (RR 1.05, 95% CI 0.92-1.20). There was no significant difference for the rate of spontaneous vaginal delivery (RR 1.06, 95% CI 0.84-1.34), operative vaginal delivery (RR 0.97, 95% CI 0.25-3.78), or cesarean delivery (RR 1.00, 95% CI 0.87-1.14).Conclusion: Membrane sweeping in patients planning a trial of labor after cesarean was not found to be effective in promoting the onset of labor. This systematic review highlights the limited data addressing the utility of membrane sweeping for women with prior cesarean delivery.

Keywords: Membrane stripping; membrane sweeping; trial of labor after cesarean; vaginal birth after cesarean.