Quality standard

Quality statement 6: Planning mode and timing of birth for women with pre-eclampsia

Quality statement 6: Planning mode and timing of birth for women with pre-eclampsia

Quality statement

Women with pre-eclampsia have an agreed consultant obstetrician-led plan for the timing and mode of birth.

Rationale

Some women who have pre-eclampsia with mild or moderate hypertension will progress to severe pre-eclampsia, which is associated with serious adverse outcomes. Because the progress of the condition differs between women, a consultant-led plan should be developed for each woman with pre-eclampsia including acceptable thresholds for intervention of all monitored thresholds (maternal and fetal) for early birth. This will be agreed with the pregnant woman, updated as needed, and will supersede any original birth plan.

Quality measures

Structure

Evidence of local arrangements to ensure that women with pre-eclampsia have an agreed consultant obstetrician-led plan for the timing and mode of birth.

Data source: Local data collection.

Process

Women with pre-eclampsia have an agreed consultant obstetrician-led plan for the timing and mode of birth documented in their notes.

Numerator – the number of women in the denominator who have an agreed consultant obstetrician-led plan for the timing and mode of birth documented in their notes.

Denominator – the number of women who have given birth who had pre-eclampsia.

Data source: The Maternity Services Secondary Uses Dataset collects data on the date a care plan has been created or changed. This covers antenatal, birth and postnatal care plans (global number 17201890). Data are also collected on the stage to which the plan applies (global number 17201900) and the professional category of the clinician with overall responsibility for care during the pregnancy (global number 17201920).

Outcome

a) Feedback from women who have had pre-eclampsia that they felt sufficiently involved in planning the timing and mode of the birth of their baby.

Data source: Local data collection.

b) Number of maternal deaths of women with pre-eclampsia.

Data source: Local data collection.

c) Number of fetal deaths for women with pre-eclampsia.

Data source: Local data collection.

d) Number of admissions of women with pre-eclampsia to intensive care units (ICU).

Data source: Local data collection.

e) Number of admissions of babies born to women with pre-eclampsia to neonatal intensive care units (NICU).

Data source: Local data collection.

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

Service providers ensure that there are local arrangements in place for women with pre-eclampsia to have an agreed consultant obstetrician-led plan for the timing and mode of birth.

Healthcare practitioners ensure that women with pre-eclampsia have an agreed consultant obstetrician-led plan for the timing and mode of birth.

Commissioners ensure they commission services that develop an agreed consultant obstetrician-led plan for the timing and mode of birth for women with pre-eclampsia.

What the quality statement means for patients, service users and carers

Women with pre-eclampsia (a pregnancy-related rise in blood pressure with protein in the urine that happens in some pregnancies) and their consultant obstetrician agree a plan for when and how they will give birth and that the plan is followed.

Source guidance

Definitions of terms used in this quality statement

The consultant obstetrician-led plan should be agreed with both the pregnant woman and the multidisciplinary team providing the woman's care, including other specialists, in particular anaesthetists. This should be done as soon after admission as possible. The birth should be according to the most up-to-date version of the plan.

Pre-eclampsia New hypertension presenting after 20 weeks of pregnancy with significant proteinuria (urinary protein:creatinine ratio greater than 30 mg/mmol or a validated 24‑hour urine collection result greater than 300 mg protein).

Timing and mode of birth For indications for timing and mode of birth, see NICE clinical guideline 107 recommendations 1.5.2.1–1.5.2.7.