The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial

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(1)Ginekol Pol. 2014, 85, 682-687. P R A C E O R Y G I N A L N E poł ożn i ct wo. The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial Wpływ oddzielenia błon płodowych na długość szyjki macicy i poród: randomizowane badanie kliniczne. +XUL\H$3DUODNJXPXV&HP<DOFLQND\D%XOHQW+D\GDUGHGHRJOX(EUX7DULP Baskent University School of Medicine, Department of Obstetrics & Gynecology, Ankara, TURKEY. Abstract Objectives: The aim of the study was to investigate to what extent sweeping of the membranes contributes to cervical shortening and if cervical shortening is related to the time to onset of labor and duration of the active phase of labor. Methods: This prospective randomized clinical trial was performed at Baskent University between February and March 2011. Women were randomly assigned to receive membrane sweeping (Sweeping Group) (n=69) or no membrane sweeping (Control Group) (n=71). Cervical length was measured (cervix1) in both groups by examiner 1 and the Bishop Score was determined in the control group and sweeping was performed in the sweeping group by examiner 2. Two days later the patients had another cervical length measurement (cervix 2) by examiner 1, blinded to the group and results of the examiner 2. t test, Mann-Whitney U test and Chi-square test were used for statistical analyses. Results: Cervix 1 was 27.4±8.4 mm and 29.6±8.9 mm (p= 0.14), cervix 2 was 23.3±8.8 mm and 23.8±8.5mm (p= 0.28) and cervical shortening was 5±4 mm and 5±4mm (p= 0.446), time to onset of labor was 6.3±4.6 and 5.7±4.1 (p= 0.38) and duration of labor was 5.8± 2.89 and 5.7± 2.4 (p= 0.82) for the sweeping and the control groups, respectively. Conclusions: Sweeping of the membranes does not reduce cervical length and does not shorten time to onset of labor and duration of the active phase of labor. NCT01309308: Sweeping the Membranes, Cervical Length and Duration of Labor. Key words: cervical length / sweeping / pregnancy / duration of labor / time to labor /. Corresponding author: H. Ayse Parlakgumus Baskent Universitesi Seyhan Arastirma ve Uygulama Hastanesi Barajyolu 1. Durak 01110 Seyhan, Adana / Turkey tel: +90 322 4586868, fax: +90 322 4599511 e-mail: ayseparlakgumus@yahoo.de. 682. Otrzymano: 04.07.2013 Zaakceptowano do druku: 14.04.2014. © Polskie Towarzystwo Ginekologiczne. Nr 9/2014.

(2) Ginekol Pol. 2014, 85, 682-687. P R A C E. O R Y G I N A L N E po ł o ż n i c t wo. Huriye A. Parlakgumus et al. The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial.. Streszczenie Cel pracy: Celem pracy była ocena w jakim stopniu oddzielenie błon płodowych wpływa na skrócenie szyjki macicy oraz czy skrócenie szyjki macicy jest związane z czasem do rozpoczęcia porodu i czasem trwania aktywnej fazy porodu. Metoda: To propektywne, randomizowane badanie zostało przeprowadzone na Uniwersytecie w Baskent pomiędzy lutym a marcem 2011 roku. Kobiety przydzielano do grupy, której oddzielano błony płodowe od szyjki macicy (Grupa badana) (n=69) lub do grupy bez wykonywania dodatkowych procedur (Grupa kontrolna) (n=71). Długość szyjki macicy mierzono w obu grupach (szyjka 1), ocenę szyjki wg skali Bishopa wykonywano w grupie kontrolnej a oddzielenie błon płodowych od szyjki macicy wykonywano w grupie badanej. Dwa dni później wykonywano ponowny pomiar długości szyjki macicy (szyjka 2) w obu grupach zaślepionych pod względem przynależności do grupy i efektów przeprowadzonego masażu szyjki macicy. Do celów statystycznych użyto testu t, U Manna-Whitneya i Chi-kwadrat. Wyniki: Szyjka 1 wynosiła 27,4±8,4mm i 29±8,9mm (p=0,14), szyjka 2 wynosiła 23,3±8,8mm i 23,8±8,5 (p=0,28) a skrócenie szyjki macicy wyniosło 5±4mm i 5±4mm (p=0,446), czas do rozpoczęcia porodu wyniósł 6,3±4,6mm i 5,7±4,1mm (p=0,38) a czas trwania porodu wyniósł 5,8±2,89 i 5,7±2,4 (p=0,28) dla grupy badanej i grupy kontrolnej, odpowiednio. Wnioski: Oddzielanie błon płodowych nie zmniejsza długości szyjki macicy, nie przyspiesza rozpoczęcia porodu ani nie skraca aktywnej fazy porodu.. Słowa kluczowe:

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(8) Ginekol Pol. 2014, 85, 682-687. P R A C E O R Y G I N A L N E poł ożn i ct wo. Huriye A. Parlakgumus et al. The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial.. Table I. -RK\KMÔ\S]^SM] KXN Z\OQXKXMc Y_^MYWO] YP ]aOOZSXQ `] MYX^\YV Q\Y_Z] P. Sweeping Group (n=69). Control Group (n=71). Age (range), y. 26 (17-40). 28 (19-41). 0.30. Nulliparity (%). 34 (49.2). 31 (43.6). 0.12. 38.5 (38-39). 38.2 (38-39). 0.13.

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(10) . 43 (62.3). 44 (61.9). 0.91. Cervix 1 (range), mm. 26.8 (9.3-48). 29.1 (8-51). 0.14. Cervix 2 (range), mm. 22 (5-46). 25 (6-43). 0.28. 3.7 (-1.8-16). 5 (-1.3-17). 0.45. ! "# $&. 6 (2-19). 4 (2-19). 0.38. #

(11) ' !. (±SD), hrs. 5.2 (2.8-15). 5 (2.1-15). 0.82. 3400 (2160-4100). 3390 (2540-4300). 0.30. Vaginal (%). 57 (82.6). 57 (80.3). 0.14. Cesarean section (%). 12 (17.4). 14 (19.7). Cervical shortening (range), mm. "# Mode of delivery. #' $ *+/: . 4 (5.8). 5 (7). 0.85. 14 (20.3). 9 (12.7). 0.22. *+/: . 4/14 (28.6). 5/9 (55.6). 0.2. Hypertension (%). 4/14 (28.6). 2/9 (22.2). 0.73. IUGR (%). 2/14 (14.3). 1/9 (11.1). 0.82. Oligohydramnios (%). 3/14 (21.4). 1/9 (11.1). 0.52. Intrahepatic cholestasis (%). 1/14 (7.1). 0/9 (0). 0.41. 2/12 (16.7). 3/14 (21.4). 0.76. 3/12 (25). 2/14 (14.3). 0.50. 5/12 (41.6). 6/14 (42.8). 0.95. -. 1/14 (7.2). 0.40. 2/12 (16.7). 2/14 (14.3). 0.50. ; $

(12) ! Indications for IOL. Indications for cesarean section Failed induction (%) Failure to progress (%) Fetal distress (%) = !$ Maternal request (%). Data are mean ± SD for continuous data and number (%) for categorical data.. +$3

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(58) (53.5%). Delivered >7 days (46.5%). p.

(59) (42.8%). Labor >5 hours (%) 57.2. P. Nulliparity (%). 38.6. 46.1. 0.42. 30. 42.5. <.001*.

(60) . 62.6. 66.1. 0.56. 66.6. 65. 0.93. Cervix1 (±SD), mm. 28.4 ± 8.3. 28.7 ±9.4. 0.80. 28.1±9.1. 28.9 ±8.6. 0.62. Cervix2 (±SD), mm. 22.5± 8.6. 24± 8.9. 0.30. 22.3 ± 8.4. 23.7 ±8.9. 0.28. Cervical shortening (±SD), mm. 5.8 ±4.1. 4.7 ±4.6. 0.12. 5.8 ±4.4. 5±4.3. 0.25. 45.3. 53.8. 0.31. 45. 52.5. 0.47. $ *Statistically significant. ZHHNV:HLQWHQGHGWR¿QGRXWLIWKH%LVKRS6FRUHFHUYL[ FHUYL[RUFHUYLFDOVKRUWHQLQJSUHGLFWGHOLYHU\ZLWKLQGD\VRI SHOYLF H[DPLQDWLRQ RU VZHHSLQJ 1RQH RI WKH SDUDPHWHUV ZHUH VLJQL¿FDQWO\ DVVRFLDWHG ZLWK GHOLYHU\ ZLWKLQ GD\V 0RUHRYHU VZHHSLQJ GLG QRW FKDQJH WKH GXUDWLRQ RI WKH DFWLYH SKDVH RI ODERU&HUYLFDOOHQJWKVEHIRUHDQGGXULQJVZHHSLQJDQGFHUYLFDO VKRUWHQLQJ ZHUH DOVR XVHOHVV LQ SUHGLFWLQJ WKH DFWLYH SKDVH RI ODERU ODVWLQJ KRXUV 2QO\ QXOOLSDULW\ ZDV VLJQL¿FDQWO\ PRUH FRPPRQ p

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Conclusions &HUYLFDO VKRUWHQLQJ LV D G\QDPLF SURFHVV ZKLFK FRQWLQXHV XQWLOODERU+RZHYHUVZHHSLQJRIWKHPHPEUDQHVGRHVQRWEULQJ DQ\ IXUWKHU UHGXFWLRQ LQ FHUYLFDO OHQJWK DQG GRHV QRW VKRUWHQ WLPHWRRQVHWRIODERUDQGGXUDWLRQRIWKHDFWLYHSKDVHRIODERU 1XOOLSDULW\LVWKHRQO\VLJQL¿FDQWSDUDPHWHULQGH¿QLQJWKHOHQJWK RIWKHDFWLYHSKDVHRIODERU0RUHVWXGLHVRQFHUYLFDOOHQJWKDUH QHFHVVDU\WREHWWHUXQGHUVWDQGFHUYLFDOG\QDPLFV. !" #$%&$%'" ( ) * + length and duration of labor )XOO GHWDLOV RI WKH WULDO SURWRFRO FDQ EH IRXQG LQ WKH 6XSSOHPHQWDU\ $SSHQGL[ DYDLODEOH ZLWK WKH IXOO WH[W RI WKLV DUWLFOHDWZZZFOLQLFDOJRYWU. Acknowledgements: We would like to thank nurses in the antenatal clinic for their help in randomization, and biostatisticians for their help in analysis of the data.. Nr 9/2014. Authors’ Contribution: 2_\ScO + :K\VKUQ_W_] q QK^RO\SXQ YP ^RO NK^K MYXMOZ^ KXKVc]S] KXN. SXÔ\Z\O^K^SYX YP NK^K K\^SMVO N\KP^ MY\\O]ZYXNSXQ K_^RY\ -OW CKVMSXUKcK q QK^RO\SXQ YP ^RO NK^K ,_VOX^ 2KcNK\NONOYQV_ q QK^RO\SXQ YP ^RO NK^K /L\_ >K\SW q \O`S]ON K\^SMVO M\S^SMKVVc Authors’ statement:. >RS] S] ^Y MO\^SPc ^RK^ ^RO Z_LVSMK^SYX aSVV XY^ `SYVKÔ ^RO MYZc\SQR^] YP K ^RS\N. ZK\^c K] _XNO\]^YYN KMMY\NSXQ ^Y ^RO +M^ SX ^RO WK^Ô\ YP MYZc\SQR^ KXN. \OVKÔN \SQR^] YP 0OL\_K\c ## 9ɽMSKV 4Y_\XKV 8Y # -VK_]O. aS^R \O]ZOM^ ^Y ^RO Ôb^ NK^K ^KLVO] KXN SVV_]^\K^SYX] Q\KZR] ºQ_\O]. ZRY^YQ\KZR]. ^RO\O S] XY mMYX»SM^ YP SXÔ\O]^]p aRSMR YMM_\] aROX ^RO K_^RY\ \OWKSX] SX. K ºXKXMSKV Y\ ZO\]YXKV \OVK^SYX]RSZ aRSMR _XT_]^Vc KɿOM^] RS]RO\ KM^SYX]. K]]YMSKÔN aS^R ^RO Z_LVSMK^SYX YP ^RO WKX_]M\SZ^. KXc ZY]]SLVO \OVK^SYX]RSZ] YP ^RO K_^RY\] aS^R ^RO ZK\^cZK\^SO] SXÔ\O]ÔN. SX ^RO Z_LVSMK^SYX YP ^RO WKX_]M\SZ^ K\O \OÒKVON SX ^RO Ôb^ YP ^RO K\^SMVO. ^RO WKX_]M\SZ^ RK] XY^ LOOX Z_LVS]RON SX Y\ ]_LWS^ÔN ^Y KXc Y^RO\ TY_\XKV. Source of financing: Baskent University Foundation Huriye Ayse Parlakgumus.. References: 1. Gulmezoglu AM, Crowther CA, Middleton P. Induction of labor for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012, 4, CD004945. 2. Caughey AB, Sundaram V, Kaimal AJ, [et al.]. Maternal and neonatal outcomes of elective induction of labor. Evid Rep Technol Assess (Full Rep). 2009, 176, 1–257. 3. Martin JA, Hamilton BE, Ventura SJ, [et al.]. Births; Final Data for 2009. Natl Vital Stat Rep. 2011, 60(1), 1. 4. Heimstad R, Romundstad PR, Eik-Nes SH, Salvesen KA. Outcomes of pregnancy beyond 37 weeks’ gestation. Obstet Gynecol. 2006, 108, 500–508. 5. National Health Service. NHS maternity statistics, England, 2007–08. National Health Service website. http, //www.ic.nhs.uk/statistics-and-datacollections/hospital-care/maternity/nhsmaternity-statistics-england, 2007-08. 6. Bishop E. Pelvic scoring for elective induction. Obstet Gynecol. 1964, 24, 266–268. 7. Tanir HM, Sener T, Yildiz Z. 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