Overview of 2020 surveillance methods

NICE's surveillance team checked whether recommendations in the NICE guideline on preterm labour and birth remain up to date.

The surveillance process consisted of:

  • Feedback from topic experts via a questionnaire.

  • A search for new or updated Cochrane reviews and national policy.

  • Consideration of evidence from previous surveillance.

  • Examining related NICE guidance and quality standards and NIHR signals.

  • A search for ongoing research.

  • Examining the NICE event tracker for relevant ongoing and published events.

  • Literature searches to identify relevant evidence.

  • Assessing the new evidence against current recommendations to determine whether or not to update sections of the guideline, or the whole guideline.

  • Consulting on the proposal not to update with stakeholders.

  • Considering comments received during consultation and making any necessary changes to the proposal.

After consultation, the decision changed to update.

For further details about the process and the possible update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Evidence considered in surveillance

Search and selection strategy

We searched for new evidence related to the whole guideline.

We found 48 studies in a search for randomised controlled trials (RCTs) published between 1 January 2015 and 31 October 2019.

We also included:

  • 1 relevant study from a total of 7 identified by topic experts

  • 5 studies identified in comments received during consultation of the 2020 surveillance proposal.

From all sources, we considered 54 studies to be relevant to the guideline.

See appendix A for details of all evidence considered, and references.

Selecting relevant studies

We searched for RCTs and systematic reviews; however, because of the large volume of studies identified, only RCTs with sample sizes of 50 and over, and Cochrane reviews, were included.

Overall, the new evidence either was considered to support the current recommendations, was outside of the scope of this guideline or was deemed insufficient in volume or quality to impact on the recommendations.

Intelligence gathered during surveillance

Views of topic experts

We considered the views of topic experts who were recruited to the NICE Centre for Guidelines Expert Advisers Panel to represent their specialty. For this surveillance review, topic experts completed a questionnaire about developments in evidence, policy and services related to the guideline.

We received 4 questionnaire responses: from a midwife, a maternal-fetal medicine and obstetrics specialist, a labour ward and delivery education lead and an obstetrics specialist. Two felt that the guideline should be updated and 2 did not express an opinion.

Areas raised in topic expert feedback included:

  • Identifying women at high risk for premature labour, which is outside of the scope for this guideline.

  • The gestational age for giving magnesium sulfate, fetal steroids and tocolytics. Only 1 study was found about the use of magnesium sulfate, which had similar effects on fetal neuroprotection regardless of gestational age and therefore supported NICE's recommendations.

  • The efficacy of progesterone (see the section on reasons for the decision).

  • Techniques for cervical cerclage (including suture material). No evidence was found in this area.

Views of stakeholders

Stakeholders are consulted on all surveillance reviews except if the whole guideline will be updated and replaced. Because this surveillance proposal was to not update the guideline, we consulted with stakeholders.

Overall, 12 stakeholders commented. Comments were received from a private healthcare company, a clinical reference group, 4 royal colleges, a university hospitals trust, a pharmacy association, an operational delivery network, a society and 2 charities. Three of the stakeholders agreed with the proposal not to update the guideline and 8 did not agree. One stakeholder did not comment. The main reasons for disagreeing with the proposal not to update included:

  • place of birth and in utero transfer

  • use of antibiotics in preterm labour

  • single and repeat use of corticosteroids.

See the section on reasons for the decision for further details.

See appendix B for full details of stakeholders' comments and our responses.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.


No equalities issues were identified during the surveillance process.

Overall decision

After considering all evidence and other intelligence and the impact on current recommendations, we decided that an update is necessary.

ISBN: 978-1-4731-3699-1

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