This is a non-inferiority trial where a stepped wedge cluster randomized controlled design will be used. This study will investigate if an antenatal care program for healthy pregnant women with a low risk for adverse outcomes could be safely monitored with fewer in-person visits to a midwife, and with some of them replaced by virtual visits. These women probably receive excessive and unnecessary antenatal care. The majority of pregnant women with a low risk assessment have an uncomplicated antenatal course without adverse events. Medical and technical advances have been significant during the last decades and the recent Covid-19 pandemic has caused a shift in health care, from in-person visits to virtual visits. The person with the greatest need should be given the most care, and the health care system should strive to be cost-efficient. Swedish health care is obliged to give care on equal conditions for the entire population. It is crucial to provide care based on individual needs. This may result in a decreased risk of requiring a formal induction of labour for postmaturity. We recommend therefore that there could be a reduction in the gestation at which membrane sweeping is offered from 40 weeks for primiparous women and 41 weeks for multiparous women to 38 weeks onwards for all low risk women without any increased risk of maternal or foetal morbidity. What the implications are of these findings for clinical practice and/or further research? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low risk pregnant women.However, the results of this review suggest that this effect is significant from 38 weeks of gestation, and is not dependent upon the number or timing of membrane sweeps performed. This study clearly demonstrates that membrane sweeping is effective in promoting a spontaneous labour and thereby reducing the need for a formal induction of labour. ![]() What the results of this study add? The results from this meta-analysis add to the body of existing evidence around membrane sweeping.) that women are offered a membrane sweep to promote spontaneous labour prior to arranging a formal induction of labour. For these reasons, it is currently recommended by The National Institute for Health and Care Excellence (NICE 2008 National Institute for Health and Care Excellence (NICE). Women's experiences of being induced for post-date pregnancy. 2010 Gatward H, Simpson M, Woodhart L, Stainton M. NHS reference costs 2014–2015 ), and the birth experience of women (Gatward et al. Cochrane Database of Systematic Reviews CD003101., ), as well as having an impact on NHS resources (Department of Health 2015 Department of Health. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. 2014 Thomas J, Fairclough A, Kavanagh J, Kelly A. American Journal of Obstetrics and Gynecology 199:34.e1–31.e5.,, Thomas et al. Effects of oxytocin-induced uterine hyperstimulation during labor on fetal oxygen status and fetal heart rate patterns. Simpson and James 2008 Simpson K, James D. However, all of the induction methods carry some degree of risk in terms of the associated morbidities and effectiveness (Cunningham 2005 Cunningham F. Consequently, a formal induction of labour is usually offered to low-risk pregnant women between 41 and 42 weeks of pregnancy. ![]() Cochrane Database of Systematic Reviews CD004945. Induction of labour for improving birth outcomes for women at or beyond term. 2012 Gulmezoglu A, Crowther C, Middleton P, Heately E.
0 Comments
Leave a Reply. |