Early Labor
Conditions
Brief summary
Membrane sweeping is a routine procedure in obstetrics in term patients. It has been shown to be effective in decreasing post term gestation and in increasing rate of spontaneous vaginal delivery when used in setting of induction of labor in nulliparous patients. The goal of this study is to determine if membranes sweeping in early labor is effective in improving delivery outcomes including decreasing rate of cesarean section.
Detailed description
This is a non-blinded randomized controlled trial. Participants will be recruited at time of presentation to triage for labor evaluation after cervical exam. Patients with a term, singleton pregnancy who present with regular, painful contractions and a Bishop score \< 7 will be recruited to the study. A random number generator will be used to create a list of random binary numbers. If the patient agrees to the study, the random number list will be used to assign the participant to membrane sweeping or no membrane sweeping. Participants assigned to membrane sweeping will have an additional exam during their initial evaluation in which the membranes will be separated from the cervix and lower part of the uterus with a finger inserted into the cervical os. This would be done with at least one rotation counterclockwise and one rotation clockwise. Those not assigned to membrane sweeping will not have an additional exam. Patients will then be managed as per their primary Obstetrics (OB) provider with the exception of no further membrane sweeping throughout the labor course. Participants are only required to participate during initial evaluation and randomization. No extra study visits are required. Due to the nature of the intervention, which requires a provider to perform a procedure, blinding will not be possible for this trial. No therapy will be withheld for any patients. Their labor course will be managed as per their primary provider using standards of care. Non-treatment group is necessary in order to exam the difference of effects between membrane sweeping and no membrane sweeping. Patients will be removed from the study if they chose to withdraw their participation. Participants will resume care as normal regardless of withdrawing study participation.
Interventions
PROCEDUREMembrane sweeping
Participants assigned to membrane sweeping will have an additional exam during their initial evaluation in which the membranes will be separated from the cervix and lower part of the uterus with a finger inserted into the cervical os. This would be done with at least one rotation counterclockwise and one rotation clockwise.
Sponsors
Johns Hopkins University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Intervention is not able to be blinded
Intervention model description
Non-blinded Randomized Controlled Trial
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* Singleton pregnancy at or after 39 weeks gestation, intact membranes, cephalic presentation, nulliparous, Bishop score \<7, English or Spanish speaking
Exclusion criteria
* Prior uterine surgery precluding vaginal delivery, maternal condition precluding vaginal delivery, fetal anomaly, prior membrane stripping
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Decrease in Cesarean delivery rate | Up to 3 weeks | Decrease in Cesarean delivery rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to delivery | Up to 3 weeks | Length of labor from randomization to delivery |
| Operative vaginal delivery rate | Up to 3 weeks | Assess a decrease in operative vaginal delivery |
| Labor augmentation rate reduction | Up to 3 weeks | Assess the reduction in the rate of labor augmentation ( via the use of oxytocin and/or amniotomy) |
Countries
United States
Outcome results
None listed