Magann 1998a.

Methods	Randomised controlled trial
Participants	Setting: Obstetric clinics at the Naval Medical Center in San Diego, California, and the University of Mississippi Medical Center in Jackson Mississippi,USA (page 891). Duration of study: not stated Participants randomised: N = 65 (79 women met the Bishop score inclusion criteria. 14 of these women were excluded for a positive fetal fibronectin test result). Inclusion criteria: “uncomplicated singleton pregnancies and were candidates for a vaginal delivery at 39 weeks’ gestation”. All women who had “Vertex presentation, no placenta previa, or other contraindications to a vaginal delivery” were invited to participate. Gestational age was determined on the basis of the patients last menstrual period, initial examination, first auscultation of fetal heart tones with an ultrasound stethoscope (Medason, Newark, Calif), ultrasonography, or both performed before 20 weeks’ gestation. Negative fetal fibronectin test result and a Bishop score ≤ 4 (page 891). Exclusion criteria: women whose “estimated date of confinement was uncertain was not included in this study”. History of previous caesarean section (page 891). Parity: mixed. Both nulliparous and multiparous women included (Table 1, page 891). Bishop score: both baseline Bishop score and Bishop score at delivery (mean +/‐SD) recorded
Interventions	Membrane stripping (n = 33): “Examination every 3 days with membrane sweeping and Bishop score determination”. “Membrane sweeping was performed by placing a finger through the cervix and performing 2 circumferential sweeps with the examining finger. If the cervix would not admit a finger, the examining finger was placed into the cervix every 3 days until the sweeping could be performed.” (page 891). Control group (n = 32): “Gentle vaginal examination only every 3 days with a Bishop score assigned.” “Examinations were continued every 3 days until spontaneous labor, rupture of the membranes, or the patient completed 41 weeks’ gestation at which time all remaining patients were admitted to labor and delivery for labor induction.” (page 891). .
Outcomes	Spontaneous labour Induction at 42 weeks Augmentation of labour Mode of birth Vaginal delivery Caesarean section
Notes	Funding: none declared Trial authors’ declaration of interest: none declared Informed consent obtained: yes: “After signing an informed consent form before the 39‐week pelvic examination” Ethical approval: “This study was approved by the Investigational Review Board at the Naval Medical Center in San Diego and the University of Mississippi Medical Center in Jackson, Mississippi.” page 891. Unable to source contact details for Dr Magann
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	“These cards had been obtained from a random number table and placed the patients in one of two groups.” Page 891.
Allocation concealment (selection bias)	Unclear risk	“a card was drawn from a consecutive series of sealed opaque envelopes.” Page 891.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants: not blinded. Personnel: not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No evidence of attrition bias.
Selective reporting (reporting bias)	Low risk	No evidence of selective outcome reporting bias.
Other bias	Low risk	Author has treated induction of labour and augmentation in labour as mutually exclusive events, e.g. if a woman has a pharmacological induction of labour with further interventions to augment contractions this still included in the data for induction of labour. Control group n = 32, 18 women had IOL at 42 weeks. A further 7/14 women had augmentation.