Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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The aim of this study was to evaluate the efficacy and the safety of membrane sweeping in promoting spontaneous labour and reducing a formal induction of labour for postmaturity. Based on articles published between 2005 and 2016, 12 electronic databases were searched. Relative risk (RR) and its 95% confidence interval (CI) were used as pooled statistics. ⋯ What the implications are of these findings for clinical practice and/or further research? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low risk pregnant women. We recommend therefore that there could be a reduction in the gestation at which membrane sweeping is offered from 40 weeks for primiparous women and 41 weeks for multiparous women to 38 weeks onwards for all low risk women without any increased risk of maternal or foetal morbidity. This may result in a decreased risk of requiring a formal induction of labour for postmaturity.
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The management of vaginal delivery appears to offer an opportunity to reduce the morbidity of pelvic floor dysfunction (PFD) which is very common in the postpartum period. Research by the authors suggests that an episiotomy is protective against PFD, in particular urinary incontinence. The aim of this subsequent audit was to see if educational intervention can alter the common medical practice of episiotomy and in turn reduce postpartum PFD. ⋯ Consequently, this study explored whether an educational intervention can change the common medical practice of episiotomy and in turn reduce postpartum PFD. What are the implications of these findings for clinical practice and/or further research? No significant difference was noted overall in the episiotomy rates as a result of the educational intervention, however, the response to the educational intervention was varied among the different types of accoucheurs with the obstetricians, obstetric registrars and student midwives significantly increasing their rate of episiotomy, whilst the midwives demonstrated no significant change. This suggests that there are contributing factors which may include past education and experience; this is an area for further research.