Evidence

2017 surveillance of caesarean section (NICE guideline CG132)

Surveillance decision

Surveillance decision

We will plan an update of the following clinical areas:

  • Woman-centred care

  • Procedural aspects

We will amend the following recommendations:

1. Recommendation 1.4.5.4

  • A footnote is to be added with reference to the HES products drug safety update.

2. Recommendation 1.4.5.6

  • A footnote is to be added explaining that proton pump inhibitors are not licensed for this indication.

3. Recommendation 1.6.3.1

  • A footnote is to be added explaining that injectable formulations of diamorphine aren't licensed for intrathecal or epidural use (off-label).

4. Recommendation 1.7.1.2

  • A footnote is to be added explaining two MHRA warnings related to the use of codeine and ibuprofen.

Reason for the decision

We found 307 new studies through surveillance of this guideline. New evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated and new questions added:

Woman-centred care

  • Planning mode of birth – what are the risks and benefits of planned caesarean section (CS) compared with planned vaginal birth for both women and babies?

Topic experts highlighted there is a need to consider long-term outcomes when planning the mode of birth. Evidence was identified about CS and its impact on maternal outcomes (risk of future ectopic pregnancy, stillbirth or miscarriage, sub-fertility) and infant outcomes (cerebral palsy, childhood obesity, asthma, bowel disease, and iron-related haematological indices).

Decision: This question should be updated.

Procedural aspects

  • Surgical techniques for CS – use of antibiotics – methods to reduce infectious morbidity at CS.

New evidence was identified in three areas: preoperative skin preparation, vaginal preparation, and of intra-abdominal irrigation. Topic experts advised that this area should be updated.

Decision: This question should be updated.

  • New review question – procedures to prevent and manage hypothermia and shivering in women having a CS.

NICE guideline CG132 does not include guidance about prophylaxis and management of hypothermia and shivering in women undergoing to CS. Evidence was identified around procedures to prevent and manage hypothermia and shivering in women having a CS. In NICE guideline CG65 hypothermia: prevention and management in adults having surgery, pregnant women are out of scope. In the previous surveillance review of NICE guideline CG65 they considered that the best place to address this issue is in NICE guideline CG132.

Decision: This question should be added.

Other clinical areas

We also found new evidence that was not thought to have an effect on current recommendations. This evidence related to provision of information, planned CS, factors reducing the likelihood of CS, procedural aspects of CS, surgical techniques for CS, care of the baby born by CS, care of the women after CS, recovery following CS; and pregnancy and childbirth after CS.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the new evidence and views of topic experts, we decided that a partial update is necessary for this guideline.

See how we made the decision for further information.


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