Recommendations for research

Recommendations for research

The guideline committee has made the following recommendations for research.

Key recommendations for research

1 Prevention of prolonged pregnancy

At what gestational age should induction of labour be offered in the subgroups of women who may be more likely to experience adverse outcomes if pregnancy continues? [2021]

For a short explanation of why the committee made the recommendation for research, see the rationale section on induction of labour for pregnancy lasting longer than 41 weeks.

Full details of the evidence and the committee's discussion are in evidence review C: induction of labour for prevention of prolonged pregnancy.

2 Prevention of prolonged pregnancy

Based on individual patient data meta-analysis, what is the optimal timing of induction of labour? [2021]

For a short explanation of why the committee made the recommendation for research, see the rationale section on induction of labour for pregnancy lasting longer than 41 weeks.

Full details of the evidence and the committee's discussion are in evidence review C: induction of labour for prevention of prolonged pregnancy.

3 Preterm prelabour rupture of membranes

What are the relative risks and benefits of induced labour versus expectant management in women whose membranes have ruptured spontaneously between 34 and 37 weeks? [2008]

Why this is important

Intrauterine sepsis is more likely to develop in pregnancies that continue after the membranes have ruptured, putting both the woman and the baby at risk. In some such pregnancies, labour begins spontaneously at a variable interval after the membranes have ruptured, avoiding the need for induction. The value of antibiotic therapy and the administration of corticosteroids to the woman is unclear in this situation. A randomised study of active versus expectant management, taking account of time since membrane rupture, gestational age and maternal therapy, would be valuable.

4 Intrauterine fetal death after previous caesarean birth

How should labour be induced in women with intrauterine fetal death who have had a previous caesarean birth, and who choose to be induced? [2021]

For a short explanation of why the committee made the recommendation for research, see the rationale section on induction of labour for intrauterine fetal death after previous caesarean birth.

Full details of the evidence and the committee's discussion are in evidence review D: induction of labour for intrauterine fetal death after previous caesarean birth.

5 Membrane sweeping

What are the effectiveness and acceptability of, and maternal satisfaction with, the following:

  • multiple versus once-only membrane sweeping, at varying gestational ages, depending on parity

  • membrane sweeping versus cervical massage? [2008]

Why this is important

Membrane sweeping is considered to be a relatively simple intervention that may positively influence the transition from maintenance of pregnancy to the onset of labour, reducing the need for formal induction of labour. However, there are disadvantages, such as possible vaginal bleeding and discomfort. Research into when and how frequently membrane sweeping should be carried out to maximise its effectiveness and acceptability would be of value.

6 Vaginal dinoprostone

What are the effectiveness, safety and maternal acceptability of:

  • different regimens of vaginal dinoprostone, stratified by: clinical indications; cervical and membrane status; parity; and previous caesarean birth

  • different management policies for unsuccessful induction of labour with vaginal dinoprostone (additional dinoprostone, oxytocin, elective caesarean birth or delay of induction, if appropriate). [2008]

Why this is important

Despite extensive studies carried out over the past 30 years to determine the most effective ways of inducing labour with vaginal dinoprostone, uncertainties remain about how best to apply these agents in terms of their dosage and timing. It would be particularly useful to understand more clearly why vaginal dinoprostone is unsuccessful in inducing labour in some women.

7 Setting for induction of labour

Is it safe, effective and cost effective to carry out induction of labour in an outpatient setting? What are the advantages and disadvantages of such an approach, taking into account women's views? [2008]

Why this is important

In line with the way healthcare has developed in many areas of acute care, there is an increasing desire to reduce the time women spend in hospital. Several units are already exploring outpatient induction of labour policies and there is a need to study this approach in order to determine relative risks and benefits, as well as acceptability to women.

  • National Institute for Health and Care Excellence (NICE)