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

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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.