Study of Stripping of Membranes at Term Gestation to Reduce Post-Term Pregnancies

Abstract

Introduction: Any pregnancy which has passed beyond the expected date of delivery is called a prolonged pregnancy & which have passed 42 weeks, 294 days is called postmaturity or post term pregnany [1], these are at an increased risk for fetal postmaturity syndrome, macrosomia, fetal intolerance of labor, oligohydramnios, meconium-stained amniotic fluid, and cesarean delivery [2]. The clinical evidence of an increased potential for these poor perinatal outcomes has triggered a movement toward increased antenatal testing between 37- 42 weeks of gestation, and cervical ripening with labor inductions at or before 42 weeks of gestation. While a ripe cervix is usually suggestive of fetal maturity to find an unripe cervix does not exclude maturity. Induction of labor is one of the most common procedures in obstetrics and is carried out in approximately 20% of pregnancies [3]. Mechanical and biochemical means have been used to affect cervical ripening and to induce labor. Methods of induction include amniotomy, membrane stripping or sweeping, prostaglandins, laminaria and oxytocin. Membrane stripping or sweeping is a commonly use procedure aimed at preventing the post term pregnancy and avoid the application of formal method of induction of labour. Aims and Objectives: 1. to determine the effectiveness & safety of membrane stripping at term pregnancy as a OPD procedure weekly which can reduce the incidence of Post term pregnancy, labour induction and its complication. 2. To determine what factors occurring after digital separation of the chorionic membranes from the lower uterine segment (membrane stripping) are involved in observed clinical changes compared with patients not so treated. Material and Methods: Study Design: This was a prospective study conducted at department of Obstetrics and Gynaecology at our hospital. Study Duration: Study was conducted during the period of duration September 2014 to September 2016. Results: After documenting the confirm gestational dating criteria and obtaining inform consent 200 patients at 37 complete week of gestation were randomly selected for the study. Data were collected from findings at 1,2,3 week and during labour, which is compaired by pearson chi-square and fischer exact test. Conclusion: Stripping of membranes is a very old procedure. This causes the release of plasma prostaglandin F2, Increase in endocervical phospholipase A activity and oxytocin release have also been observed. This will initiate uterine contraction and onset of labour. It is safe, cheap, effective and even an out patient procedure. It is associated with earlier delivery and decreased incidence of posterm gestation and hence maternal and fetal complication related to post maturity.