Excerpt

This guideline reviews the evidence for the care of women who present with signs and symptoms of preterm labour and those who are scheduled to have a preterm birth. It also reviews how preterm birth can be optimally diagnosed in symptomatic women, given that many women thought to be in preterm labour when clinically assessed will not deliver preterm. Optimal diagnosis can facilitate transfer to a place where appropriate neonatal intensive care can be provided, a strategy known to improve rates of survival for the baby. Additional areas that will be covered by the guidance (such as information needs for women who presents with signs and symptoms of preterm labour) are outlined in the guideline scope.

This guideline does not cover who should and should not have medically indicated preterm delivery, nor diagnostic or predictive tests in asymptomatic women. These issues have been reviewed in other NICE guidelines (Diabetes in Pregnancy, Hypertensive Disease in Pregnancy and Antenatal Care) or will be covered in the NICE guideline on High Risk Intrapartum Care.

Contents

• Introduction
• 1. Guideline summary
  • 1.1. Guideline Committee membership, NCC-WCH staff and acknowledgements
  • 1.2. Care algorithm
  • 1.3. Recommendations
  • 1.4. Key research recommendations
  • 1.5. Research recommendations
  • 1.6. Other versions of the guideline
  • 1.7. Schedule for updating the guideline
• 2. Guideline development methodology
  • 2.1. Development of the guideline
  • 2.2. Methods
  • 2.3. Evidence of cost effectiveness
  • 2.4. Developing recommendations
• 3. Information and support
  • 3.1. Introduction
  • 3.2. Review question
  • 3.3. Description of included studies
  • 3.4. Evidence profile
  • 3.5. Evidence statements
  • 3.6. Health economics profile
  • 3.7. Evidence to recommendations
  • 3.8. Recommendations
• 4. Prevention of preterm birth
  • 4.1. Introduction
  • 4.2. Prophylactic progesterone
  • 4.3. Prophylactic cervical cerclage
  • 4.4. Recommendations
  • 4.5. Research recommendations
• 5. Diagnosing preterm prelabour rupture of membranes (P-PROM)
  • 5.1. Introduction
  • 5.2. Review question
  • 5.3. Description of included studies
  • 5.4. Evidence profile
  • 5.5. Evidence statements
  • 5.6. Health economics profile
  • 5.7. Evidence to recommendations
  • 5.8. Recommendations
• 6. Antenatal prophylactic antibiotics for women with P-PROM
  • 6.1. Introduction
  • 6.2. Review question
  • 6.3. Description of included studies
  • 6.4. Evidence profile
  • 6.5. Evidence statements
  • 6.6. Health economics profile
  • 6.7. Evidence to recommendations
  • 6.8. Recommendations
• 7. Identifying infection in women with P-PROM
  • 7.1. Introduction
  • 7.2. Review question
  • 7.3. Description of included studies
  • 7.4. Evidence profile
  • 7.5. Evidence statements
  • 7.6. Health economics profile
  • 7.7. Evidence to recommendations
  • 7.8. Recommendations
  • 7.9. Research recommendations
• 8. ‘Rescue’ cervical cerclage
  • 8.1. Introduction
  • 8.2. Review question
  • 8.3. Description of included studies
  • 8.4. Evidence profile
  • 8.5. Evidence statements
  • 8.6. Health economics profile
  • 8.7. Evidence to recommendations
  • 8.8. Recommendations
  • 8.9. Research recommendations
• 9. Diagnosing preterm labour in women with intact membranes
  • 9.1. Introduction
  • 9.2. Review question
  • 9.3. Description of included studies
  • 9.4. Evidence profile
  • 9.5. Evidence statements
  • 9.6. Health economics profile
  • 9.7. Evidence to recommendations
  • 9.8. Recommendations
• 10. Tocolysis
  • 10.1. Introduction
  • 10.2. Review question
  • 10.3. Description of included evidence
  • 10.4. Introduction to the new network meta-analysis
  • 10.5. Introduction to pair-wise meta-analysis
  • 10.6. Evidence profile
  • 10.7. Evidence profiles for the pairwise comparisons
  • 10.8. Evidence statements on NMA results
  • 10.9. Evidence statements on pair-wise comparisons
  • 10.10. Health economics profile
  • 10.11. Evidence to recommendations
  • 10.12. Recommendations
• 11. Maternal corticosteroids
  • 11.1. Introduction
  • 11.2. Single course of maternal corticosteroids at different gestations
  • 11.3. Repeat course corticosteroids for fetal lung maturation
  • 11.4. Recommendations
• 12. Magnesium sulfate for neuroprotection
  • 12.1. Introduction
  • 12.2. Review question
  • 12.3. Description of included studies
  • 12.4. Evidence profile
  • 12.5. Evidence statements
  • 12.6. Health economics profile
  • 12.7. Evidence to recommendations
  • 12.8. Recommendations
  • 12.9. Research recommendations
• 13. Fetal monitoring
  • 13.1. Introduction
  • 13.2. Interpretation of the fetal heart rate (FHR) pattern
  • 13.3. Monitoring options: cardiotocography and intermittent auscultation
  • 13.4. Fetal scalp electrode
  • 13.5. Fetal blood sampling
  • 13.6. Recommendations
  • 13.7. Research recommendations
• 14. Mode of birth
  • 14.1. Introduction
  • 14.2. Review question
  • 14.3. Description of included studies
  • 14.4. Evidence profile
  • 14.5. Evidence statements
  • 14.6. Health economics profile
  • 14.7. Evidence to recommendations
  • 14.8. Recommendations
• 15. Timing of cord clamping for preterm babies
  • 15.1. Introduction
  • 15.2. Review question
  • 15.3. Description of included studies
  • 15.4. Evidence profile
  • 15.5. Evidence statements
  • 15.6. Health economics profile
  • 15.7. Evidence to recommendations
  • 15.8. Recommendations
  • 15.9. Research recommendations
• 16. Health economics
  • 16.1. What is the clinical effectiveness of prophylactic progesterone (vaginal or oral) in preventing preterm labour in pregnant women considered to be at risk of preterm labour and birth?
  • 16.2. What is the diagnostic accuracy of the following (alone or in combination) in women with intact membranes to identify preterm labour leading to preterm birth
  • 16.3. What is the clinical and cost effectiveness of magnesium sulfate given to women at high risk of giving birth preterm (defined as those suspected to be in preterm labour or diagnosed as being in preterm labour and those having planned preterm birth) for preventing cerebral palsy and other neurological disorders in babies born at different preterm gestations?
  • 16.4. What is the clinical and cost effectiveness of tocolytics given to women with suspected or diagnosed preterm labour to improve outcomes
• 17. Glossary and abbreviations
• 18. References
• Appendices
  • Appendix A. Scope
  • Appendix B. Stakeholders
  • Appendix C. Declarations of interest
  • Appendix D. Review protocols
  • Appendix E. Search strategies
  • Appendix F. PRISMA flow diagrams
  • Appendix G. Excluded studies
  • Appendix H. Evidence tables
  • Appendix I. Forest plots
  • Appendix J. Network meta-analysis of tocolytics

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.