Quality statement 1: Intrapartum antibiotics

Quality statement

Pregnant women whose babies are at risk of early‑onset neonatal infection are offered intrapartum antibiotic prophylaxis and given the first dose as soon as possible.

Rationale

Giving intrapartum antibiotic prophylaxis to women whose babies are at risk of early‑onset neonatal infection (for example, from group B Streptococcus) can prevent early‑onset neonatal infection. The first dose should be given as soon as possible after the onset of labour because intrapartum antibiotic prophylaxis is most effective when the baby has sufficient exposure to the antibiotic.

Quality measures

Structure

Evidence of local arrangements to ensure that pregnant women whose babies are at risk of early‑onset neonatal infection are offered intrapartum antibiotic prophylaxis and given the first dose as soon as possible.

Data source: Local data collection.

Process

a) Proportion of pregnant women whose babies are at risk of early‑onset neonatal infection who receive intrapartum antibiotic prophylaxis.

Numerator – the number in the denominator who receive intrapartum antibiotic prophylaxis.

Denominator – the number of pregnant women whose babies are at risk of early‑onset neonatal infection.

Data source: Local data collection. Data can be collected using NICE's intrapartum antibiotics clinical audit tool, audit standards 1 and 2.

b) Proportion of pregnant women receiving intrapartum antibiotic prophylaxis who are given it as soon as possible.

Numerator – the number in the denominator whose intrapartum antibiotic prophylaxis is given as soon as possible.

Denominator – the number of pregnant women who receive intrapartum antibiotic prophylaxis.

Data source: Local data collection. Data can be collected using NICE's intrapartum antibiotics clinical audit tool, audit standard 3a, which includes a note on potential timeframes for audit purposes.

Outcome

Rates of early‑onset neonatal infection.

Data source: Local data collection.

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

Service providers (maternity care services) ensure that systems and protocols are in place to enable intrapartum antibiotic prophylaxis to be offered to pregnant women whose babies are at risk of early‑onset neonatal infection, and ensure that they are given the first dose as soon as possible.

Healthcare professionals adhere to protocols and offer intrapartum antibiotic prophylaxis to pregnant women whose babies are at risk of early‑onset neonatal infection, ensuring that they are given the first dose as soon as possible and record this.

Commissioners (clinical commissioning groups) specify that maternity care providers have systems and protocols in place for healthcare professionals to offer intrapartum antibiotic prophylaxis to pregnant women whose babies are at risk of early‑onset neonatal infection, and ensure that they are given the first dose as soon as possible.

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

Pregnant women who had a previous baby with an infection called group B  Streptococcus, or whose tests during this pregnancy show group B  Streptococcus bacteria in their bodies, are offered antibiotics and given the first dose as soon as possible after their labour has started.

Source guidance

Definitions of terms used in this quality statement

As soon as possible

Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.3.1.2 states that if a woman decides to take intrapartum antibiotic prophylaxis, the first dose should be given as soon as possible. A suggested definition for audit purposes is that the first dose is given within 1 hour of the onset of active labour, or within 1 hour of admission if the woman is already in active labour. [Adapted from NICE's intrapartum antibiotics clinical audit tool, audit standard 3a]

Babies who are at risk of early‑onset neonatal infection

Babies are at risk of early‑onset neonatal infection if the mother has had a previous baby with an invasive group B streptococcal infection, or has group B streptococcal colonisation, bacteriuria or infection in the current pregnancy. [Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendation 1.3.1.1]

Intrapartum antibiotic prophylaxis

Intravenous benzylpenicillin is given during labour, starting as soon as possible after labour has begun, and is continued until the baby is born.

For women who have an allergy to penicillin, clindamycin is used, unless individual group B streptococcus sensitivity results or local microbiological surveillance data indicate a different antibiotic. [Adapted from Antibiotics for early-onset neonatal infection (NICE guideline CG149) recommendations 1.3.1.2 and 1.3.1.5, and Group B streptococcal disease, early-onset (green-top guideline no. 36) (Royal College of Obstetricians and Gynaecologists)]