Launceston General Hospital Clinical Guideline (01/2012) SDMS ID: P2011/0862-001 Ref No: WACS ClinProc1.

21/2012 Title: Replaces: Description: Target Audience: Key Words: Policy Supported: Membrane Sweeping (Stretch and Sweep) New Guideline Stretch and Sweep or membrane sweeping may be performed to promote prostaglandin release in order to avoid a formal induction of labour Midwives and medical officers, QVMU
P2010/0321-001 Induction of Labour for Post Maturity: LGH Protocol 1.10-07WACS

Membrane Sweeping (Stretch and Sweep) INDICATION Sweeping or stripping the membranes involves a digital separation of the membranes from the lower uterine section during a vaginal examination, and maybe done to reduce the need for an induction of labour (IOL) and encouraging spontaneous labour by promoting the stimulation of prostaglandin synthesis and cervical ripening, RISKS Slight increase in the frequency of pre labour rupture of membranes. Associated with discomfort, vaginal bleeding and irregular contractions. BENEFITS Reduced need for formal IOL, particularly in multiparous women. Repeated membrane sweeping has been found to decrease the proportion of post term pregnancies and can be considered from 38 40 weeks and onwards. Membrane sweeping may increase successful vaginal delivery rates. CONTRAINDICATIONS Any condition where there may be a contradiction to IOL e.g. Planned elective caesarean section, any bleeding in pregnancy, placenta praevia or low lying placenta, mal presentation or head not engaged, cord presentation, foetal abnormalities, vasa praevia, active genital herpes, cervical carcinoma. PROCEDURE At the 40 and 41 week visit for nulliparous women, and the 41 week visit for multiparous women, a vaginal examination for membrane sweeping may be offered.

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The Midwives (ANC and Team), and Registrars should assess low risk women by the following parameters: 1. Review Maternal History: Confirm Gestation Assess for contra indications such as a low-lying placental site before membrane sweeping. Abdominal palpation to confirm presentation and engagement Assessment of membrane status Assessment of foetal well being. Consent must be obtained for membrane sweeping and documented in the womans records. Vaginal examination to assess the cervix: Membrane sweeping involves the examining finger passing through the cervix to rotate against the wall of the uterus to separate the chorionic membrane from the decidua. If the cervix will not admit a finger, massaging around the cervix in vaginal fornices may achieve a similar effect with the resulting release of prostaglandins. Ongoing management should be discussed with the woman including further follow up i.e. foetal movements, CTG, AFI with a 4B booking for IOL. (Hyperlink please)

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RESPONSIBILITIES: DEFINITIONS: (IOL) Induction of Labour (CTG) Cardiotocograph (AFI) Amniotic Fluid Index (IUGR) Intra uterine growth retardation Team: Mode of care of women of low risk which includes antenatal, intrapartum and postnatal by midwives in collaboration with medical/obstetric personnel as per ANMC guidelines. RELATED DOCUMENTS: P2010/0314-001 Antenatal Care WACS ClinProc 1.1/09 P2010/0314-001 Induction of Labour for Post Maturity WACS ClinProc 1.10/07 Overall Responsibility: Co Directors of WACS Medical staff Midwives at 40/41 assessment

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ATTACHMENTS: 1. References

Prepared by E. Fisher Through Through S. McBeath Dr. A Dennis

QCIM Co Director (Midwifery /Nursing) WACS Co. Director (Medical) WACS

63488107 63488976. Phone No.

Date 3.1.12 Date 3.1.12 Date 3.1.12

AUTHORISED BY Co Directors of Womens and Childrens Services Dr. A Dennis ..18 April 2012 Date: April 2012 Co-Director (Medical) Co-Director (Nursing/Midwifery) Sue McBeath 18 April 2012

REFERENCES: Boulvain M, Stan C and Irion O, 2010, Membrane sweeping for induction of labour Cochrane Pregnancy and Childbirth Group Published Online: 20 JAN 2010 DOI: 10.1002/14651858.CD000451.pub2, Viewed 3.11.11
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000451.pub2/full#jumpTo

Grampians Rural Health Alliance. Maternity Services. Online 16/11/11

http://www.grampianshealth.org.au/index.php?option=com_docman&task=cat_view&gid=50&Itemid=12&limitstart=50

McCarthy F P, Kenny L C, 2010 Induction of labour Obstetrics, Gynaecology and reproductive medicine 21:1 Pages 1-6, January 2011, Elsevier LTD
http://www.obstetrics-gynaecology-journal.com/issues?issue_key=S1751-7214(10)X0013-6

National Institute for Health and Clinical Excellence (NICE), 2008 Induction of labour National Collaborating Centre for Womens and Childrens Health, Online 3.11.11
http://guidance.nice.org.uk/CG70/Guidance/pdf/English

Queensland Maternity and Neonatal Clinical Guidelines 2011 Induction of Labour online 3.11.11
http://www.health.qld.gov.au/qcg/html/publications.asp

South Australian Perinatal Practice Guidelines 2010, Induction of labour techniques SA Health Government of South Australia
http://www.health.sa.gov.au/ppg/Default.aspx?tabid=41

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