Key priorities for implementation

Key priorities for implementation

Information and decision-making

  • Women should be informed that most women will go into labour spontaneously by 42 weeks. At the 38 week antenatal visit, all women should be offered information about the risks associated with pregnancies that last longer than 42 weeks, and their options. The information should cover:

    • membrane sweeping:

      • that membrane sweeping makes spontaneous labour more likely, and so reduces the need for formal induction of labour to prevent prolonged pregnancy

      • what a membrane sweep is

      • that discomfort and vaginal bleeding are possible from the procedure

    • induction of labour between 41+0 and 42+0 weeks

    • expectant management.

  • Healthcare professionals should explain the following points to women being offered induction of labour:

    • the reasons for induction being offered

    • when, where and how induction could be carried out

    • the arrangements for support and pain relief (recognising that women are likely to find induced labour more painful than spontaneous labour) (see also and

    • the alternative options if the woman chooses not to have induction of labour

    • the risks and benefits of induction of labour in specific circumstances and the proposed induction methods

    • that induction may not be successful and what the woman's options would be.

Induction of labour to prevent prolonged pregnancy

  • Women with uncomplicated pregnancies should usually be offered induction of labour between 41+0 and 42+0 weeks to avoid the risks of prolonged pregnancy. The exact timing should take into account the woman's preferences and local circumstances.

Preterm prelabour rupture of membranes

  • If a woman has preterm prelabour rupture of membranes after 34 weeks, the maternity team should discuss the following factors with her before a decision is made about whether to induce labour, using vaginal prostaglandin E2 (PGE2)[1]:

    • risks to the woman (for example, sepsis, possible need for caesarean section)

    • risks to the baby (for example, sepsis, problems relating to preterm birth)

    • local availability of neonatal intensive care facilities.

Vaginal PGE 2

  • Vaginal PGE2 is the preferred method of induction of labour, unless there are specific clinical reasons for not using it (in particular the risk of uterine hyperstimulation). It should be administered as a gel, tablet or controlled-release pessary. Costs may vary over time, and trusts/units should take this into consideration when prescribing PGE2. For doses, refer to the SPCs. The recommended regimens are:

    • one cycle of vaginal PGE2 tablets or gel: one dose, followed by a second dose after 6 hours if labour is not established (up to a maximum of two doses)

    • one cycle of vaginal PGE2 controlled-release pessary: one dose over 24 hours.

Failed induction

  • If induction fails, healthcare professionals should discuss this with the woman and provide support. The woman's condition and the pregnancy in general should be fully reassessed, and fetal wellbeing should be assessed using electronic fetal monitoring.

  • If induction fails, the subsequent management options include:

    • a further attempt to induce labour (the timing should depend on the clinical situation and the woman's wishes)

    • caesarean section (refer to 'Caesarean section' [NICE clinical guideline 13]).

[1] Vaginal PGE2 has been used in UK practice for many years in women with ruptured membranes. However, the SPCs (July 2008) advise that in this situation, vaginal PGE2 is either not recommended or should be used with caution, depending on the preparation (gel, tablet or pessary). Healthcare professionals should refer to the individual SPCs before prescribing vaginal PGE2 for women with ruptured membranes, and informed consent should be obtained and documented.

  • National Institute for Health and Care Excellence (NICE)