This quality standard covers care for pregnant women who are considered to be at risk of, or with symptoms and signs of, preterm labour and birth. It does not cover women with a multiple pregnancy. For more information see the preterm labour and birth topic overview.

Why this quality standard is needed

Preterm birth (that is, before 37 weeks of pregnancy) is the single biggest cause of neonatal mortality and morbidity in the UK. Babies born preterm have high rates of early, late and post neonatal mortality, and the risk of mortality increases as gestational age at birth decreases. Babies who survive have increased rates of disability.

The most important long-term consequence of prematurity is neurodevelopmental disability. This can range from severe motor abnormalities, such as cerebral palsy, to less severe cognitive disabilities. Although the risk for the individual child is greatest for those born at the earliest gestational ages, the global burden of neurodevelopmental disabilities depends on the number of babies born at each of these gestations, and so is very significant for babies born between 32 and 36 weeks, less for those born between 28 and 31 weeks, and least for those born at less than 28 weeks of gestation.

Around 75% of women delivering preterm do so after preterm labour, which may or may not be preceded by preterm prelabour rupture of membranes (P-PROM). The remaining 25% have a planned preterm birth because of medical complications (for example, extreme growth retardation in the baby or maternal conditions such as pre-eclampsia).

The quality standard is expected to contribute to improvements in the following outcomes:

  • incidence of preterm births

  • fetal morbidity and mortality

  • neonatal morbidity and mortality

  • maternal morbidity

  • neurodevelopmental disabilities

  • women's experience of childbirth.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS outcomes framework 2016–17


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults ii Children and young people

1c Neonatal mortality and stillbirths

Improvement areas

Reducing mortality in children

1.6 i Infant mortality*

4 Ensuring that people have a positive experience of care

Overarching indicators

4c Friends and family test

4d Patient experience characterised as poor or worse

i Primary care

ii Hospital care

Improvement areas

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Alignment with Public health outcomes framework

* Indicator is shared

Indicators in italics in development

Table 2 Public health outcomes framework for England, 2016–19


Objectives and indicators

4 Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, whilst reducing the gap between communities


4.01 Infant mortality*

4.03 Mortality rate from causes considered preventable**

Alignment with NHS outcomes framework

* Indicator is shared

** Indicator is complementary

Safety and people's experience of care

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to pregnant women who are considered to be at risk of preterm labour and birth.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. This specifies that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. It also covers the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic-specific quality standards. However, recommendations in the development sources for quality standards that affect people's experience of using services are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for preterm labour and birth specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole preterm labour and birth care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to pregnant women who are considered to be at risk of preterm labour and birth.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality preterm labour and birth service are listed in related quality standards.

Resource impact considerations

NICE quality standards should be achievable by local services. The potential resource impact is considered by the quality standards advisory committee, drawing on resource impact work for the source guidance. Organisations are encouraged to use the costing statement for the NICE guideline on preterm labour and birth to help estimate local costs.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating pregnant women who are considered to be at risk of preterm labour and birth should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting pregnant women who are considered to be at risk of preterm labour and birth. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.