STRETCHING OF THE CERVIX AND STRIPPING OF THE MEMBRANES AT TERM - A RANDOMIZED CONTROLLED-STUDY

Objective: To determine whether routine antepartum stretching of the c ervix and stripping of the membranes at term would shorten the length of pregnancies, and whether this correlated with cervical status and f etal and maternal parameters. Design: A prospective, randomised, contr olled study of 293 term gravidas, free of medical complications, divid ed into two groups: stretching/stripping, and non-stretching/stripping . Digital separation of the fetal membranes from the lower uterine seg ment, and cervical stretching, were performed during routine vaginal e xamination of the first group. In the second group, only routine vagin al examination was performed. Results: Of 293 patients, 152 underwent a trial of stretching and stripping; 141 served as a control group. Th e mean interval (hours to delivery after the procedure) was 136 h (S.D . 10), compared to 161 h (S.D. 11) in the control group (P=0.095; not significant), but with only a trend towards the shorter interval in th e first group. When patients were matched according to weeks of gestat ion and fetal and maternal parameters, only those at 41 weeks' gestati on or more had a significant reduction in the interval from the proced ure to delivery (mean 91 h (S.D. 8) compared to mean 125 h (S.D. 10) i n the control group; P < 0.007). This observation was independent of c ervical status and other maternal or fetal parameters. Conclusions: On ly patients greater than or equal to 41 weeks' gestation benefitted fr om stretching of the cervix and stripping of the fetal membranes. The effect was not dependent on the cervical status or other maternal and fetal parameters.