Quality statement 4: Tocolysis for women between 26+0 and 33+6 weeks of pregnancy

Quality statement

Women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis.

Rationale

For women in suspected preterm labour, tocolysis 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 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are currently offered this treatment. It is important that the potential benefits and risks of this treatment 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.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis.

Data source: Local data collection.

Process

a) Proportion of women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour who receive tocolysis.

Numerator – the number in the denominator who receive tocolysis.

Denominator – the number of women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed 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 different audiences

Service providers (such as secondary or tertiary care services) ensure that women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis as appropriate.

Healthcare professionals (such as midwives and obstetricians) offer tocolysis as appropriate to women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour.

Commissioners (clinical commissioning groups) commission services that ensure that women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis as appropriate.

Women who are more than 26 weeks but less than 34 weeks pregnant and in suspected or diagnosed preterm labour are offered tocolytics (medicines that slow down or stop labour) if these medicines are likely to help their baby. The benefits and risks of this treatment are explained to them.

Source guidance

Preterm labour and birth (2015, updated 2019) NICE guideline NG25, recommendation 1.8.3

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's guideline on preterm labour and birth, terms used in this guideline]

Diagnosed preterm labour

A woman is in diagnosed preterm labour if she is in suspected preterm labour and has had a positive diagnostic test for preterm labour.

[NICE's guideline on preterm labour and birth, terms used in this guideline]

Tocolysis

Drugs used to stop or delay the progress of labour. The NICE guideline recommends nifedipine[4] as the first choice, or oxytocin receptor antagonists if nifedipine is contraindicated.

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



[4] Although this is common in UK clinical practice, at the time of publication (August 2019), nifedipine did not have a UK marketing authorisation for this indication. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing Guidance: prescribing unlicensed medicines for further information. The suggested dose of nifedipine is a loading dose of 20 mg nifedipine orally, followed by 10 mg to 20 mg 3 to 4 times daily, adjusted according to uterine activity. At the time of publication, some brands of nifedipine were specifically contraindicated in pregnancy by the manufacturer in their summary of product characteristics. Refer to individual summaries of product characteristics for each preparation of nifedipine for further details.