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Research Article

Comparison of cervical massage with membrane sweeping for pre-induction cervical ripening at term; a randomized controlled trial

Authors:

S. S. Yaddehige ,

Bedford Hospital NHS Trust, GB
About S. S.
Registrar in Obstetrics and Gynaecology
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H. D. Kalansooriya,

Teaching Hospital Mahamodara, LK
About H. D.
Consultant in obstetric and gyaecology
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M. F. M. Rameez

University of Ruhuna, LK
About M. F. M.
Senior Lecturer, Faculty of Medicine
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Abstract

Introduction: Membrane sweeping is a common method of pre induction cervical ripening. However, this may not be possible if the cervical os is closed. Cervical massage has been proposed as an alternative under these circumstances. Whilst there are a large number of clinical trials which endorse the effectiveness of membrane sweeping, the effectiveness of cervical massage in comparison with membrane sweeping has not been researched.

 

Objective: To compare the effectiveness of cervical massage as a ripening method in post dated pregnancies prior to induction of labour against membrane sweep in tertiary care hospital in Sri Lanka.

 

Methods: A total of 165 singleton low risk pregnancies at 40 weeks +4 days gestation between August 2013 and May 2014 were included in the study. All these women were assessed to have Modified Bishop Score (MBS) less than 4. These women were randomly assigned to either undergo cervical massage, membrane sweeping or neither of these procedures as the control group. The favorability of the cervix was measured by a change in the MBS 48 hours after the intervention. Complications such as rupture of membrane, intrapartum infection, postpartum infection and neonatal morbidity were also assessed.

 

Results: There were no significant differences in the mean age and MBS at recruitment in the primigravidae and multigravidae, between the three study groups. There was a significant increase in the mean MBS after intervention in the cervical massage group (in primigravidae 6.4, 95% CI 4.8-8.0, in multigravidae 7.2, 95% CI 6.1-8.4) and membrane sweeping groups (in both primigravidae and multigravidae 7.6, 95% CI 6.2-9.0) compared to control group (in primigravidae 5.3, 95% CI 4.0-6.5, in multigravidae 4.8, 95% CI 3.8-5.8. Hence the change in the MBS post intervention was significant in both primigravidae and multigravidae. Adverse effects and neonatal morbidity were similar in all three groups with the exception of cardiotocographic abnormalities which were reported more often in the control group.

 

Conclusion: Cervical massage and membrane sweeping showed significant effect on improvement of the MBS at term as pre induction cervical ripening method. The complication rates with cervical massage are comparable to membrane sweeping. Cervical massage is hence an effective and safe alternative to membrane sweeping when the latter cannot be performed owing to a closed cervical os.

How to Cite: Yaddehige, S.S., Kalansooriya, H.D. and Rameez, M.F.M., 2019. Comparison of cervical massage with membrane sweeping for pre-induction cervical ripening at term; a randomized controlled trial. Sri Lanka Journal of Obstetrics and Gynaecology, 41(3), pp.66–74. DOI: http://doi.org/10.4038/sljog.v41i3.7883
Published on 24 Oct 2019.
Peer Reviewed

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