Effect of membrane sweeping on cervical length by transvaginal ultrasonography and impact of cervical shortening on cesarean delivery.
OBJECTIVE
The purpose of this study was to evaluate cervical length changes after membrane sweeping and the effect of cervical shortening on pregnancy outcomes.


METHODS
Low-risk women at 40 weeks' gestation undergoing membrane sweeping to expedite labor were recruited. Participants were scheduled for labor induction at 41 weeks' gestation. Transvaginal ultrasonography was performed immediately before and after membrane sweeping to measure the cervical length. Three presweep and postsweep cervical lengths were measured. The shortest lengths before and after the sweep were taken as the representative lengths. The effect of membrane sweeping on cervical length was analyzed. Multivariable logistic regression analysis was performed to evaluate the effect of cervical shortening on labor induction and the mode of delivery.


RESULTS
For the 160 participants, the mean presweep cervical length ± SD was 21.0 ± 10.0 mm; the postsweep length was 23.8 ± 10.9 mm, an average increase of 2.8 ± 0.6 mm (P < .001). Cervical shortening after membrane sweeping was noted in 53 of 160 cases (33%). Cervical shortening was associated with a reduction in all-cause cesarean delivery but not labor induction on bivariate analysis. After adjustment for maternal age, parity, presweep Bishop score, postsweep cervical length, oxytocin augmentation, epidural analgesia, and meconium-stained fluid, cervical shortening after membrane sweeping was independently predictive of a reduction in cesarean deliveries (adjusted odds ratio, 0.24; 95% confidence interval, 0.06-0.90; P = .034).


CONCLUSIONS
Membrane sweeping was associated with lengthening of the cervix. A shortened cervix after sweeping was independently predictive of vaginal delivery.
Department of Obstetrics and Gynecology, University of Malaya, Kuala Lumpur, Malaysia. pctan@um.edu.my
Peng Chiong
PC
Tan
Pwint Phyu
PP
Khine
Nur Halimanja
NH
Sabdin
Narayanan
N
Vallikkannu
Sofiah
S
Sulaiman
D020070:Cervical Ripening; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods; D011247:Pregnancy; D014463:Ultrasonography