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  6. Membrane sweep for prolonged pregnancy (412)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Membrane sweep for prolonged pregnancy (412)

Objectives

This guideline covers the reasoning behind why a membrane sweep may be performed at term and the process of this procedure. It aims to give women the option to have membrane sweeping to possibly prevent prolonged pregnancy and reduce the need for mechanical or pharmacological induction of labour.

Scope

This procedure can be carried out, with informed consent, by healthcare professionals i.e. Midwives and Obstetricians.

Audience

Healthcare professionals
Pregnant women, their families and carers

Please report any inaccuracies or issues with this guideline using our online form

Who is suitable for a membrane sweep?

Pregnant women

  • After 39 weeks gestation who has given consent.
  • After previous caesarean birth if planning vaginal birth (VBAC). If a VBAC is the planned method of birth then a membrane sweep is not contraindicated.

Who is not suitable for a membrane sweep?

Pregnant woman who

  • Has been confirmed to have a placenta praevia.
  • Has had undiagnosed bleeding in third trimester.
  • Baby’s head high and not in pelvis.
  • Previous caesarean birth not planning vaginal birth
  • Woman for whom a vaginal birth is not suitable.

Advantages of a membrane sweep

  • Can prevent prolonged pregnancy.
  • May make it more likely the woman will labour spontaneously.
  • May reduce the need for mechanical or pharmacological induction of labour.
  • Can be repeated if spontaneous labour does not occur

Disadvantages of a membrane sweep

  •  Woman may experience some discomfort during the procedure.
  • May cause some light vaginal bleeding.
  • May not lead to spontaneous labour.

Procedure

A membrane sweep can be discussed with the woman in the latter stages of the third trimester and offered from 39 weeks gestation and performed at the both community midwife led and obstetric led antenatal clinics. The woman should be informed of the advantages and disadvantages of a membrane sweep to allow them to make an informed decision whether to have the procedure. The procedure should be discussed and verbal consent must be gained, from the pregnant person, before carrying out the membrane sweep.

Research suggest membrane sweeps performed twice weekly after 39 weeks are more effective than once weekly or no membrane sweep. Clinical judgement and women’s choice should be considered when arranging subsequent follow up.

  • Prior to the membrane sweep the woman should empty their bladder.
  • An abdominal palpation should be carried out to ascertain that presentation is cephalic and the vertex is in the pelvis. If not, then the procedure should not be performed.
  • The fetal heart should be auscultated prior to the procedure.
  • After gaining consent to start the procedure a vaginal examination should be performed.
  • To sweep the membranes, first locate the cervix.
  • A finger should then be passed through the cervix, if possible, and rotated against the wall of the uterus, to separate the membranes from the uterus.
  • If the cervix will not admit a finger, massaging around the cervix in the vaginal fornices may achieve a similar effect.
  • After the procedure the fetal heart should be auscultated again.
  • All findings should be discussed with the woman and documented on Badgernet.

The pregnant person should be informed that they may experience some light vaginal bleeding or ‘Show’. If any heavy bleeding, painful contractions or waters breaking (SROM) maternity assessment unit should be contacted. A discussion regarding whether the woman would like additional membrane sweeping should take place if spontaneous labour does not occur after the first sweep.

Editorial Information

Last reviewed: 14/12/2023

Next review date: 15/12/2028

Author(s): Elaine Drennan.

Version: 3

Co-Author(s): Kirsty Robertson, Laura Paterson.

Approved By: Maternity Clinical Governance Group

Document Id: 412

References

Finucane EM, Murphy DJ, Biesty LM, et al. Membrane sweeping for induction of labour. Cochrane Database of Systematic Reviews. 2020(2)

NICE (2021). Inducing labour (NG 207) – Section 1.3: Methods for induction of labour.

Salau JO et al. Effectiveness and safety of membrane sweeping in the prevention of post-term pregnancy: a randomised controlled trial. J Obstet Gynaecol. 2022 Sep 30:1-7.