The difference is not significant statistically. The number of patients who had spontaneous onset of labour in the control group was 48 i.e. 61.3 %, patients went into labour after sweeping.
Twenty five patients (33.3%) underwent two sweeping of which seven patients had onset of labour. In study group, 50 patients (66.7%) underwent only one sweeping of which 39 patients had onset of labour. Outcomes measured were number of patients who had spontaneous onset of labour primarily and secondarily successful Vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval, amount of oxytocin required and mean gestational age at delivery. Primary and secondary outcomes were assessed. Any condition requiring immediate delivery was excluded from the study and was managed according to the institutional protocol. All the cases were monitored by daily Non Stress Test, amniotic fluid index was measured once in every three days till onset of labour or 41 weeks. In control group (no sweep), gentle vaginal examination was done once at 39 weeks for Bishop scoring and no further examination was done till the onset of labour. When the cervix was closed attempts to stretch the cervix open or cervical massage was performed. During vaginal examination, if cervix admitted one finger, the foetal membranes were separated from the cervix and the lower uterine segmentas far as possible by sweeping a finger through 360 degrees. In study group (sweep), for all patients bishop scoring was recorded. Participants involved in the study were recruited after taking written informed consent and re assigned into two groups by the sequential opening of numbered sealed opaque envelopes indicating a “sweep” or “No Sweep”. Biparietal diameter, head circumference and femur length during second trimester. Previous LSCS patients who satisfied the inclusion and exclusion criteria were selected and their gestational age was confirmed by Naegele’s rule or by ultrasonic measurement of crown rump length of the foetus during first trimester or by foetal biometry i.e. Exclusion criteria were multiple gestations, malpresentations, placenta praevia, abruptioplacentae, suspected cephalo-pelvic disproportion, gestational diabetes, chronic or gestational hypertension, pre eclampsia, gestational age less than 39 weeks, H/O premature ruptures of membranes, vasa praevia, congenital anomalies, any previous abortions, More than one transverse lower segment caesarean scar, Previous classical caesarean scar, any other uterine surgeries related to gynaecology. Inclusion criteria were women with one previous caesarean section with non-recurrent indications, singleton pregnancy and cephalic presentation, gestational age of 39 weeks, intact membrane and candidates willing for VBAC. A total of 150 antenatal mothers who fulfil the inclusion criteria were considered (75 in study arm and 75 in control arm). The study was conducted at antenatal outpatient department of Mahatma Gandhi Medical College and Research Institute during January 2011 to June 2012 after obtaining Ethical committee clearance.
STRETCH AND SWEEP VBAC SERIAL
With this background it is an effort to find out the effect of serial membrane sweeping on the onset of labour in antenatal woman with previous LSCS, who wished to undergo planned VBAC. Promoting earlier onset of labour within term in women planning VBAC can be advantageous because the need for induction of labour may be avoided and prolongation of pregnancy further into late term with its risk of stillbirth may be reduced. There is a paucity of data within context of membrane sweeping after caesarean delivery.
STRETCH AND SWEEP VBAC TRIAL
Clinical guidelines continue to suggest that most women with one previous caesarean delivery with a low transverse incision were the candidates for VBAC and should be counselled and offered a trial of labour. Induction of labour at planned VBAC is acceptable after careful counselling and risk assessment.
Induction of labour and scarred uteri is associated with uterine rupture which in turn massively increases the risk of neonatal mortality.
Induction of labour is associated with a failed trial after vaginal birth after caesarean section (VBAC) resulting in a repeat caesarean delivery. A recent Cochrane meta-analysis of membrane sweeping trials concluded that it reduces the number of women progressing to post-term gestation and the need for formal labour induction. Recent guidance suggests that membrane sweeping can be offered at term to promote labour and avoid induction of labour for prolonged pregnancy. Membrane sweeping at term is effective in expediting delivery and reducing the need for formal induction of labour.
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