Induction of labour; efficacy of sweeping of membranes at term in previous one C-section

ABSTRACT

It is now widely accepted that trial for vaginal delivery should be attempted unless a genuine indication exists for C- section. To determine the efficacy of membrane sweeping for onset of labor till 41 weeks of gestation and mode of delivery in patients with previous one cesarean section [C-Section]. Randomized control trial. Department of Obstetrics and Gynaecology, Benazir Bhutto hospital, Rawalpindi. Jan 2008 to Dec 2008. Pregnant women with previous one C- section were randomly allocated to Group-A [sweeping of membrane] and Group-B [no intervention] each having 55 patients. There was no absolute indication of cesarean section in present pregnancy. After complete antenatal examination, tests like CBC, urine DR, BSR, urea, creatitnine, screening for hepatitis B and C were done. In group A, digital sweeping of fetal membranes was started a 37 weeks and was done every 3rd day till she went into the labor or she reached 41 weeks. At 41 weeks of gestation, if she did not go into labor, induction with prostaglandin or elective C-section was done depending upon the bishop score. In group B, patients awaited spontaneous onset of labor till 41 weeks. After 41 weeks induction with prostaglandin or elective C- cesarean section was done. In Group A, 43 [78.18%] patients had onset of labour after sweeping of membranes while 12 [21.82%] patients had no onset of labour. In Group-B, 28 patients [50.90%] had spontaneous onset of labor while 27 [49.10%] had no onset of labours. In Group-A, 34 [61.82%] patients and in Group-B only 14 [25.45%] were delivered vaginally [p Value 0.001]. In Group-A, lower segment cesarean section was done in 6 [10.91%] patients while in Group-B, 23 [41.82%] had cesarean section [p Value 0.001]. Assisted vaginal delivery was done in 15 [27.27%] in Group-A while 18 [32.73%] patients in Group-B had assisted vaginal delivery [p Value 0.533]. In patients with previous one cesarean section, the efficacy of membrane sweeping in terms of onset of labor and normal vaginal delivery is significantly higher as compared to patients who had no sweeping of membranes