Quality standard

Quality statement 1: Providing information about potential signs and symptoms of preterm labour

Quality statement 1: Providing information about potential signs and symptoms of preterm labour

Quality statement

Pregnant women at increased risk of preterm labour are given information about the potential signs and symptoms.

Rationale

Not all pregnant women at increased risk of preterm labour know what symptoms and signs to look out for. At such a vulnerable time in their lives, women and their families need information about the potential signs and symptoms of preterm labour and the care available that meets their needs and supports shared decision making, without causing unnecessary anxiety.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements and clinical protocols to ensure that pregnant women at increased risk of preterm labour are given information about the potential signs and symptoms.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications and clinical protocols.

Process

Proportion of pregnant women at increased risk of preterm labour who are given information about the potential signs and symptoms.

Numerator – the number in the denominator who are given information about the potential signs and symptoms.

Denominator – the number of pregnant women at increased risk of preterm labour.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Pregnant women's satisfaction with the information provided.

Data source: No routinely collected national data has been identified for this measure. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from maternity surveys.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that pregnant women at increased risk of preterm labour are given written information about the potential signs and symptoms by healthcare professionals, who also discuss this with them.

Healthcare professionals (such as midwives and obstetricians) give written information to pregnant women at increased risk of preterm labour about the potential signs and symptoms, and discuss this with them.

Commissioners (clinical commissioning groups or integrated care systems) commission services that ensure that pregnant women at increased risk of preterm labour are given written information about the potential signs and symptoms by healthcare professionals, who also discuss this with them.

Pregnant women at increased risk of preterm labour (that is, going into labour before the 37th week of pregnancy) are given written information about the signs and symptoms that might suggest preterm labour. A healthcare professional also talks to them about this and the care available.

Source guidance

Preterm labour and birth. NICE guideline NG25 (2015, updated 2022), recommendation 1.1.1

Definitions of terms used in this quality statement

Pregnant women at increased risk of preterm labour

Pregnant women who:

  • have a history of:

    • spontaneous preterm birth

    • preterm prelabour rupture of membranes (P-PROM)

    • loss (from 16+0 weeks of pregnancy onwards)

    • cervical trauma (including surgery – for example, previous cone biopsy [cold knife or laser], large loop excision of the transformation zone [LLETZ – any number] and radical diathermy)

  • are considered to be at risk of preterm labour and birth because they have a short cervix (25 mm or less) that has been identified on a transvaginal ultrasound scan and/or bulging membranes in the current pregnancy

  • have P-PROM.

[Adapted from NICE's full guideline on preterm labour and birth]

Information

Pregnant women should be given oral and written information, and be directed to organisations that can provide further support. [Adapted from NICE's full guideline on preterm labour and birth]

Potential signs of preterm labour

Potential signs could include:

  • watery, mucosal or bloody vaginal discharge

  • regular or frequent (often painless) contractions or uterine tightening

  • P-PROM.

[Expert opinion]

Potential symptoms of preterm labour

Potential symptoms could include:

  • pelvic or lower abdominal pressure

  • constant low, dull backache

  • mild abdominal cramps, with or without diarrhoea.

[Expert opinion]

Equality and diversity considerations

Pregnant women at increased risk of preterm labour should have access to information that is understandable if they:

  • have additional needs, such as physical, sensory or learning disabilities

  • do not speak or read English

  • have religious, ethnic or cultural needs.

Interpreters and advocates should be provided if needed.

For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.