Summary of findings 4. Amniotic membranes sweeping compared to vaginal/oral misoprostol for induction of labour.

Amniotic membrane sweeping compared to vaginal/oral misoprostol for induction of labour
Patient or population: pregnant women carrying a live fetus at or near term (≥ 36 weeks' gestation). Setting: antenatal environments where amniotic membrane sweeping is likely to be used. Intervention: amniotic membrane sweeping Comparison: vaginal/oral misoprostol
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with vaginal/oral misoprostol	Risk with amniotic membrane sweeping
Spontaneous onset of labour ‐ not reported	‐	‐	‐	‐	‐	This outcome was not reported.
Induction of labour ‐ not reported	‐	‐	‐	‐	‐	This outcome was not reported.
Caesarean section	Study population		RR 0.82 (0.31 to 2.17)	96 (1 RCT)	⊕⊕⊝⊝ LOW 1 2
	160 per 1000	131 per 1000 (50 to 347)
Spontaneous vaginal birth ‐ not reported	‐	‐	‐	‐	‐	This outcome was not reported
Uterine hyperstimulation with/without fetal heart rate (FHR) changes ‐ not reported	‐	‐	‐	‐	‐	This outcome was not reported
Maternal death or serious maternal morbidity	‐	‐	‐	‐	‐	This outcome was not reported
Neonatal death or serious neonatal perinatal morbidity ‐ not reported	‐	‐	‐	‐	‐	This outcome was not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

¹ We downgraded (1) level for risk of serious bias due to evidence of design limitations in this trial. We found high risk of performance bias and an unclear risk of both detection bias and reporting bias.

² We downgraded (1) level for risk of serious imprecision due to the total (cumulative) sample size of 96 being less than the optimal information size (OIS) of 3776