[CG] Membrane sweep postdates – midwifery guidance

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1. Introduction

Sweeping the membranes is a procedure that encourages the release of prostaglandins around the cervix. Following a risk assessment, this procedure should be discussed with all women at 38 weeks and offered as close to 41 weeks as possible. Women should be offered one sweep, but should they request, consideration may be given to repeating the process at a later date.

2. Evidence

NICE (2008) and RCOG (2001) suggest that sweeping the membranes is likely to increase the chance of spontaneous labour within 48 hours and birth within one week, therefore reducing the need for prostaglandins. There is no suggestion of an increased risk of infection although it may increase the incidence of prelabour rupture of membranes. There is no difference in the rates of operative delivery.

Sweeping the membranes is effective in bringing on labour but causes discomfort, some bleeding and irregular contractions. Sweeping the membranes during a cervical examination is done to bring on labour in women at term. The review of trials found that sweeping brings on labour and is generally safe where there are no other complications. Sweeping reduces the need for other methods of labour induction such as oxytocin or prostaglandins. The review also found that sweeping can cause discomfort during the procedure, some bleeding and irregular contractions (Cochrane Database of Systematic Reviews, 2005).

3. Contraindications

Sweeping of the membranes should not be performed if:-

  • There is a confirmed placenta praevia.
  • The vertex is not in the pelvis.
  • There has been any undiagnosed vaginal bleeding in the third trimester.

4. Procedure

Membrane sweeps may be carried out in a home, community or hospital setting. It is essential that informed consent is given by the woman prior to carrying out the procedure. Women should be aware of the potential for PV bleeding and discomfort.

  • Obtain informed consent
  • Ensure the woman has emptied her bladder prior to the procedure
  • Perform an abdominal palpation to ensure cephalic presentation with engagement of the fetal head
  • Auscultate the fetal heart prior to the procedure
  • Perform membrane sweep
  • Clearly if the cervix will not admit a finger it may not be possible to strip the membranes but in such cases massaging around the cervix in the vaginal fornices may achieve a similar effect.
  • Auscultate the fetal heart following the procedure.
  • Discuss the findings with the woman and document in the Badgernet electronic record.

5. Advice to Women

  • The procedure may be uncomfortable.
  • Slight vaginal bleeding or “show” may be experienced following the procedure,
  • Heavy bleeding, regular painful contractions or SROM should prompt self referral to Maternity unit

6. Documentation

Record the findings in the appropriate section of the Badgernet electronic record

References

Cochrane database of Systematic Reviews, 24th January 2005, reviewed 2009

Enkin M, Keirse M J N C Neilson J et al 2000 A guide to effective care in pregnancy and childbirth. Oxford University Press Oxford

NICE (National Institute for Clinical Excellence) 2008 Induction of labour NICE London

NICE (National Institute for Clinical Excellence) 2008 Antenatal Guideline

RCOG (Royal College of Obstetricians and Gynaecologists) 2001 Induction of labour RCOG London

Last reviewed: 18 February 2019

Next review: 01 April 2021

Author(s): Elaine Drennan