The obstetrical staff performed membrane stripping after explanation and obtaining patient’s consent to the procedure. The Hadassah Medical Organization Institutional Review Board approved the STRIP-G study and waived the requirement for informed consent (IRB N°: 0204-11-HMO). Postpartum, maternal and neonatal outcomes were collected along with maternal and newborn discharge summaries by trained study investigators. Detailed demographic data and medical, prenatal and antenatal history, was extracted by trained staff using the patients' electronic medical records.
GBS-positive women were considered “exposed”, and the comparison groups consisted of women who were GBS-screening negative and those with unknown-GBS status. We excluded from this study women with a closed cervix, multiple gestation pregnancies, pregnancies with major fetal anomalies, and those who were not candidates for vaginal delivery (placenta previa, breech presentation, planned cesarean delivery). All candidates for vaginal delivery with a singleton pregnancy and confirmed cephalic presentation between 37 0/7 and 41 6/7 weeks' gestational age were eligible. The study population consisted of all women who underwent membrane stripping at this hospital between Octoand December 31, 2013. We conducted a prospective observational cohort study in the maternal-fetal unit of a tertiary center university teaching hospital with approximately 5,000 deliveries per year. In order to further elucidate the effect of antepartum membrane stripping in GBS carriers, we conducted a prospective study, the STRIP-G study, which examined whether the rates of adverse neonatal and maternal outcomes differ by GBS carrier status among women undergoing membrane stripping. Given the rare neonatal morbidity caused by GBS sepsis as well as the lack of well-powered studies designed to address the safety of membrane stripping in known GBS carriers, approaches are inconsistent,, and consensus has not been reached regarding whether antepartum membrane stripping in GBS carriers adversely affects maternal or neonatal outcomes. They concluded that the subject has not been investigated in well-designed prospective studies and therefore data are insufficient to encourage or discourage this practice in women known to be GBS-colonized. Their latest guidelines discuss the risks of membrane stripping in women colonized with GBS. Both the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control (CDC) do not consider GBS colonization as a contraindication to membrane stripping. However, based on the theoretical increased risk of bacterial seeding, as well as concern for fast labor which would prevent the administration of adequate antibiotic prophylaxis after membrane stripping, some practitioners choose not to sweep the membranes in GBS colonized patients. Ī recent Cochrane review confirmed that membrane stripping does not increase the risk of maternal and neonatal infection, however this review did not analyze the outcomes by GBS carrier state. It is estimated that 20–30% of all pregnant women are colonized with GBS. Early onset neonatal GBS disease, defined as infection presenting in the first 7 days of life, has a broad clinical spectrum of ranging from mild illness that resolves spontaneously within several days, to severe respiratory disease, meningitis, neonatal sepsis, and death. Streptococcus agalactiae (Group B Streptococcus (GBS)) is the leading major cause of early neonatal sepsis and an important pathogen associate with maternal peripartum infection. Adverse effects commonly reported following the procedure are limited to transient maternal discomfort during the procedure, irregular uterine contractions, and clinically insignificant vaginal bleeding.
Several studies have reported that membrane stripping is associated with higher rates of spontaneous vaginal delivery, shorter induction-to-delivery interval, reduced likelihood of post-term pregnancy, and a decrease in the need for induction of labor.
This maneuver is thought to initiate a cascade of physiological reactions in which local production of prostaglandins promotes cervical ripening and may lead to the onset of active labor. The procedure is performed during a vaginal examination, by separating the chorioamniotic membrane from the lower uterine segment by a circular movement of the finger. Stripping or sweeping of the fetal membranes is a widely utilized technique to hasten delivery, first described by James Hamilton in 1810.
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