Magann 1998b.

Methods	Randomised controlled trial.
Participants	Setting: Naval Medical Center, San Diego, California, USA (Page 1279). Duration of study: 6 months (March 1996 to September 1996) (Page 1279). Participants randomised: n = 105 Inclusion criteria: no contraindication to a vaginal delivery. Bishop score ≤ 4. Uncomplicated pregnancy. ≥ 41 weeks' gestation. Informed consent signed (Page 1279). Exclusion criteria: contraindication to a pelvic examination, i.e. placenta praevia, rupture of membranes (Page 1279). Parity: mixed. Both nulliparous and multiparous women included (Page 1280, Table II). Bishop score: Bishop score at entry (mean +/‐SD) recorded
Interventions	Membrane sweeping group: n = 35 “daily membrane stripping performed” (Page 1280). Prostaglandin group: n = 35 “0.5mg of prostaglandin E2 (PGE2) gel placed into the cervix on a daily basis as an outpatient.” (Page 1280). Control group: n = 35 “gentle daily cervical examination” “All patients were examined to determine Bishop scoring by one of the two examiners who were blinded to group assessment.” “If the Bishop score totaled ≥8 or the patient reached the forty second week of pregnancy the patient was admitted for induction of labour.” All patients received a modified biophysical profile (NST and amniotic fluid index) every 3 days except for those women in the prostaglandin group who had daily biophysical profiling after the insertion of the intracervical prostaglandin (Page 1280).
Outcomes	Spontaneous onset of labour Formal induction of labour Induction at 42 weeks Spontaneous vaginal delivery Caesarean section delivery Forceps delivery Apgar < 7 at 5 minutes Cost analysis
Notes	Funding: “Departments of Obstetrics and Gynecology, Naval Medical Center and University of Mississippi Medical Center. Supported in part by the Vicksburg Hospital Medical Foundation.” page 1279. Trial authors’ declaration of interest: none declared Informed consent obtained: yes Ethical approval: “study was approved by the Institutional Review Board” page 1280. Unable to source contact details for Dr Magann
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	“patients were randomly assigned to one of the groups by drawing the next in a series of opaque sealed envelopes that had been generated from a random number table”, page 1280.
Allocation concealment (selection bias)	Unclear risk	"by drawing next in series of opaque sealed envelopes” page 1280.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants: not reported Personnel: “All patients were examined to determine Bishop scoring by one of the two examiners who were blinded to group assessment.” Further blinding of personnel not discussed, page 1280.
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 reporting bias.
Other bias	Low risk	No evidence of other bias.