Quality statement 4: Tocolysis and corticosteroids for women in suspected preterm labour between 26+0 and 29+6 weeks of pregnancy

Quality statement

Women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour are offered tocolysis and maternal corticosteroids.

Rationale

For women in suspected preterm labour, tocolysis and maternal corticosteroids may delay the birth and reduce the risk of problems such as cerebral palsy and of neonatal death. Not all women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour are currently offered these treatments. It is important that the potential benefits and risks of both of these treatments are discussed with the woman and her family members. Tocolysis is appropriate only under particular circumstances, and a range of factors need to be taken into account. Giving corticosteroids to a woman before a preterm birth reduces the severity of lung disease of prematurity and of other associated complications for her baby. Maternal corticosteroids also have the potential to reduce the number of days that the baby needs to be on a ventilator.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour are offered tocolysis and maternal corticosteroids.

Data source: Local data collection.

Process

a) Proportion of women between 26+0 and 29+6 weeks of pregnancy in suspected preterm labour who receive tocolysis.

Numerator – the number in the denominator who receive tocolysis.

Denominator – the number of women between 26+0 and 29+6 weeks of pregnancy in suspected preterm labour.

Data source: Local data collection.

b) Proportion of women between 26+0 and 29+6 weeks of pregnancy in suspected preterm labour who receive maternal corticosteroids.

Numerator – the number in the denominator who receive maternal corticosteroids.

Denominator – the number of women between 26+0 and 29+6 weeks of pregnancy in suspected preterm labour.

Data source: Local data collection.

Outcome

a) Neonatal death.

Data source: Local data collection.

b) Intraventricular haemorrhage.

Data source: Local data collection.

c) Incidence of neonatal sepsis.

Data source: Local data collection.

d) Use of antibiotics.

Data source: Local data collection.

e) Ventilation.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as secondary or tertiary care services) ensure that women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour are offered tocolysis and maternal corticosteroids as appropriate.

Healthcare professionals (such as midwives and obstetricians) offer tocolysis and maternal corticosteroids as appropriate to women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour.

Commissioners (clinical commissioning groups) commission services that ensure that women between 26+0 and 29+6 weeks of pregnancy who are in suspected preterm labour are offered tocolysis and maternal corticosteroids as appropriate.

What the quality statement means for women and their companions

Women who are more than 26 weeks but less than 30 weeks pregnant and in suspected preterm labour are offered tocolytics (medicines that slow down or stop labour) and steroid injections (to help the baby's lungs develop before the birth) if these medicines are likely to help their baby. The benefits and risks of each of these treatments are explained to them.

Source guidance

Definitions of terms used in this quality statement

Suspected preterm labour

A woman is in suspected preterm labour if she has reported symptoms of preterm labour and has had a clinical assessment (including a speculum or digital vaginal examination) that confirms the possibility of preterm labour but rules out established labour.

[NICE guideline on preterm labour and birth]

Tocolysis

Drugs used to stop or delay the progress of labour. The NICE guideline recommends nifedipine as the first choice, or oxytocin receptor antagonists if nifedipine is contraindicated.

[NICE full guideline on preterm labour and birth]

Maternal corticosteroids

Corticosteroids (glucocorticosteroids) are anti-inflammatory medicines given to the woman (usually by intramuscular injection) which cross the placenta and accelerate fetal lung maturation.

[NICE full guideline on preterm labour and birth]