Therefore, theĮarlier assumption that the likelihood of intra-amniotic infection Infection correlates to poor neonatal outcomes. Has also been shown that the degree of severity of intra-amniotic It has also been reported that markers of inflammation found within the amniotic cavity in approximately 26% of suspected cases of intra amniotic infection followingĪmniocentesis in women without the rupture of membranes. Approximately 40 years ago, it was shown that bacteria could cause intra-amniotic infection even in the presence of “intact” amniotic membranes. Any disturbance to the closed cervix can lead to dislodgement of the protective mucous plug and thereby promoting the microbial ascent through the cervix into the amniotic cavity (Figure 1). However, recent evidence has shown that the endocervical epithelium and the cervical mucous plug have significant innate and adaptive immune functions. ![]() In addition, a long and a closed uterine cervix along with the mucous plug within the cervical canal provides a mechanical barrier which prevents any ascending infection from the vagina into the amniotic cavity. The function of the cervix is to provide mechanical strength to retain the growing fetus until term. This makes it more susceptible to colonization and infection by bacteria that normally reside in the vagina and rectum during pregnancy and in labor. The pregnant uterus is anatomically connected to the vagina through the cervix. The mucosa of the vagina is continuous with the skin of the thigh, perineum and has an anatomical proximity to the anal canalĪnd the rectum. What are the Potential Risks of the “Membrane Sweeping”? A Bishop’s score to assess the cervical length, dilatation, effacement, consistency position of cervix and fetal descent is used to predict the prognosis of the membrane sweep and the induction process. Mc Colgin confirmed that the membrane sweep was associated with an increased activity of prostaglandin F2 and phospholipase A. Membrane sweeping was first suggested by James Hamilton in 1810 for labor induction. Membrane stripping or sweeping involves a vaginal examination during which a finger is introduced into the cervical os to separate the membranes from the lower uterine segment by a circular movement. History and Practice of “Membrane sweeping” (Artificial Separation of Membranes or “ASOM”) Keywords: Artificial separation of membranes Membrane sweep Ascending infection Zig Zag Pattern Prostaglandins ColonizationĪbbreviations: CTG: Cardiotocograph NHS: National Health Service ASOM: Artificial Separation of Membranes GBS: Group -B, Streptococcus ![]() Midwives and obstetricians owe their patients a duty of care to weigh the reported benefits of the ASOM against the potential risks of fetal infection, whilst recommending this historical practice which was introduced prior to the advent of chemical (e.g., prostaglandins), or mechanical (e.g., cervical balloon catheters) methods, in contemporary obstetric practice. We have analyzed the current systematic evidence on the “Membrane Sweep” to determine its efficacy. On the other hand, there are potential risks of introducing bacteria from the maternal vagina into the chorio-decidual space, increasing the risks of inflammation and infection. questioned the efficacy of the “Membrane Sweep”, as the likelihood of a spontaneous labor was found to be very modest and with no reduction in operative deliveries or an increase in spontaneous vaginal births following ASOM. In the absence of other chemical and mechanical methods to ensure cervical ripening, the “Membrane Sweep” became established in obstetric practice for approximately 200 years. ![]() The “membrane sweep” or artificial separation of membranes (ASOM) was introduced into clinical practice to artificially initiate labor, and to avoid the risks of a prolonged pregnancy. The Historical Practice of “Membrane Sweep” to Initiate Labour: Does it Have a Role in Contemporary How to cite this article: Suganya S, Edwin C. *Corresponding author: Edwin Chandraharan, Director, Global Academy of Medical Education & Training, London &, Consultant Intrapartum Care Advisor, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Essex, UK To Initiate Labour: Does it Have a Role in Contemporary Obstetric Practice? Suganya Sukumaran 1 and Edwin Chandraharan 2*ġObstetrics & Gynaecology, South Warwickshire NHS Foundation Trust, UKĢGlobal Academy of Medical Education & Training, Basildon University Hospital, UK Research Article The Historical Practice of “Membrane Sweep”
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