Вскрытие плодного пузыря для стимуляции (индукции) родов

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Вскрытие плодного пузыря является эффективным способом стимуляции (индукции) родов, но вызывает дискомфорт, небольшое кровотечение и нерегулярные схватки.

Вскрытие плодного пузыря проводят во время осмотра шейки матки для стимуляции родов у женщин, у которых подошел срок. Обзор исследований показал, что вскрытие плодного пузыря приводит к родам и, как правило, является безопасным, если нет других осложнений. Вскрытие плодного пузыря уменьшает потребность в других методах стимуляции родов, таких как окситоцин или простагландины. Этот обзор также показал, что вскрытие плодного пузыря может вызвать дискомфорт во время процедуры, небольшое кровотечение и нерегулярные схватки.

Выводы авторов: 

Routine use of sweeping of membranes from 38 weeks of pregnancy onwards does not seem to produce clinically important benefits. When used as a means for induction of labour, the reduction in the use of more formal methods of induction needs to be balanced against women's discomfort and other adverse effects.

[Note: The 11 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

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Введение и актуальность: 

Sweeping of the membranes, also named stripping of the membranes, is a relatively simple technique usually performed without admission to hospital. During vaginal examination, the clinician's finger is introduced into the cervical os. Then, the inferior pole of the membranes is detached from the lower uterine segment by a circular movement of the examining finger. This intervention has the potential to initiate labour by increasing local production of prostaglandins and, thus, reduce pregnancy duration or pre-empt formal induction of labour with either oxytocin, prostaglandins or amniotomy. This is one of a series of reviews of methods of cervical ripening and labour induction using standardised methodology.


To determine the effects of membrane sweeping for third trimester induction of labour.

Методы поиска: 

We searched the Cochrane Pregnancy and Childbirth Group trials register (6 July 2004) and bibliographies of relevant papers.

We updated this search on 31 July 2009 and added the results to the awaiting classification section.

Критерии отбора: 

Clinical trials comparing membrane sweeping used for third trimester cervical ripening or labour induction with placebo/no treatment or other methods listed above it on a predefined list of labour induction methods.

Сбор и анализ данных: 

A strategy was developed to deal with the large volume and complexity of trial data relating to labour induction. This involved a two-stage method of data extraction.

Основные результаты: 

Twenty-two trials (2797 women) were included, 20 comparing sweeping of membranes with no treatment, three comparing sweeping with prostaglandins and one comparing sweeping with oxytocin (two studies reported more than one comparison). Risk of caesarean section was similar between groups (relative risk (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.15). Sweeping of the membranes, performed as a general policy in women at term, was associated with reduced duration of pregnancy and reduced frequency of pregnancy continuing beyond 41 weeks (RR 0.59, 95% CI 0.46 to 0.74) and 42 weeks (RR 0.28, 95% CI 0.15 to 0.50). To avoid one formal induction of labour, sweeping of membranes must be performed in eight women (NNT = 8). There was no evidence of a difference in the risk of maternal or neonatal infection. Discomfort during vaginal examination and other adverse effects (bleeding, irregular contractions) were more frequently reported by women allocated to sweeping. Studies comparing sweeping with prostaglandin administration are of limited sample size and do not provide evidence of benefit.