Membrane Sweeping Matches Double-Balloon Catheter for Cervical Ripening Effectiveness in Term Pregnancies

Effective cervical ripening is crucial for successful labor induction in term pregnancies. While membrane sweeping is a simple, safe, and cost-effective method known to promote spontaneous labor and reduce the need for formal induction, its direct comparative efficacy against mechanical methods like the double-balloon catheter has been underexplored. Current standards often rely on prostaglandins or oxytocin, but membrane sweeping offers a less invasive alternative. This study addresses the gap in direct comparative evidence between these two common cervical ripening techniques.

This randomized controlled trial enrolled 114 term pregnancies with intact membranes requiring cervical ripening at a tertiary center. Participants were randomized to either membrane sweeping (performed twice: at admission and 4-6 hours later) or double-balloon catheter insertion (for 12 hours). Exclusion criteria included prior cervical ripening or sweeping, and previous cesarean delivery. The primary outcome was the change in Bishop score (Δ Bishop score) from baseline to 12 hours post-intervention. Secondary outcomes included time to cervical ripening and delivery, oxytocin use, obstetric/neonatal outcomes, pain (VAS), and patient satisfaction. The study was powered for non-inferiority, requiring ≥25 participants per group.

Of the 114 patients randomized (60 to membrane sweeping; 54 to double-balloon catheter), 107 were analyzed per protocol (57 in the membrane sweeping group; 50 in the double-balloon catheter group). Baseline characteristics and initial Bishop scores were similar between both groups, ensuring a balanced comparison. The primary outcome revealed no significant difference in effectiveness between the two methods for cervical ripening. At 12 hours post-intervention, the median Δ Bishop score was found to be comparable:

2 [1-3] for the membrane sweeping group versus 2 [1-3] for the double-balloon catheter group (p=0.657). This indicates that both interventions achieved a similar degree of cervical change. While secondary outcomes such as time to cervical ripening, delivery, oxytocin use, and pain were assessed, specific numerical results for these endpoints were not detailed in the abstract, suggesting the primary outcome was the main focus of the reported findings.