Membrane sweeping in term pregnancy to promote spontaneous labor and prevent post-term pregnancy: a systematic review and meta-analysis.

BACKGROUND

Membrane sweeping is recommended to facilitate spontaneous labor, reduce the need for formal induction, and prevent post-term pregnancy. However, its overall effects on maternal and neonatal outcomes remain unclear. This study aims to evaluate the impact of membrane sweeping in term pregnancy on maternal and neonatal outcomes.

METHODS

The initial search was conducted through December 19, 2023, and an updated search extended the inclusion of publications to July 15, 2025. Study selection and data extraction were done independently by two researchers. The Cochrane risk of bias 2.0 tool was used to evaluate study quality. Data analysis was performed using R 4.5.0, calculating mean differences with 95% confidence intervals (CIs) for continuous outcomes and relative risk (RR) for dichotomous outcomes. Subgroup analyses were conducted based on the timing and frequency of membrane sweeping. Meta-regression was applied to identify factors influencing results, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to evaluate evidence certainty.

RESULTS

Thirty-four randomized controlled trials involving 6355 pregnant women were included. Meta-analyses indicated that membrane sweeping significantly promoted spontaneous labor (RR = 1.28, 95% CI: 1.16, 1.41, I2 = 82.6%) and reduced formal induction of labor (RR = 0.66, 95% CI: 0.51, 0.85, I2 = 79.5%). Membrane sweeping at 40 weeks to 40 weeks and 6 days significantly increased the spontaneous delivery and reduced induction. Single membrane sweeping significantly improved spontaneous labor and reduced induction. Compared with routine care, membrane sweeping may prevent post-term pregnancy, increase vaginal delivery rates, reduce cesarean sections, and shorten the delivery interval. No significant differences were found in premature rupture of membranes, intrapartum fever, postpartum fever, or meconium-stained liquor. For neonatal outcomes, meta-analysis showed that membrane sweeping significantly reduced neonatal intensive care unit admission rates, whereas no difference in neonatal infection rates was observed. Limited evidence indicated significantly lower proportions of 1- and 5-minute Apgar scores < 7 in the membrane-sweeping group.

CONCLUSIONS

Our findings suggest that membrane sweeping may be an effective and relatively safe method for labor induction. Given the low certainty of the evidence, high-quality randomized controlled trials are urgently needed to corroborate these exploratory findings.

REGISTRATION: CRD42023494189 (PROSPERO).