Cg070slideset

Induction of labour Implementing NICE guidance

2008 NICE clinical guideline 70

Updated guidance

This guideline replaces ‘Induction of labour’ (NICE inherited clinical guideline D, June 2001)

What this presentation covers Scope Key priorities for implementation Costs and savings Discussion Find out more

Scope For induction of labour in a hospital-based maternity unit setting, this guideline covers: • clinical indications, methods and timing • the care and information women should be offered •management of complications such as failed induction

Key priorities for implementation •Information and decision-making –at the 38 week antenatal check –when offering induction •Prevention of prolonged pregnancy •Preterm prelabour rupture of membranes •Vaginal prostaglandin E2 (Vaginal PGE2) •Failed induction

At the 38 week antenatal check Tell women that most people will go into labour spontaneously by 42 weeks. Offer all women information about the risks associated with pregnancies that last longer than 42 weeks, and their options.

When offering induction Tell women: •the reasons for induction being offered • when, where and how it could be carried out • arrangements for support and pain relief • alternative options • risks, benefits and methods of induction • that it may not work, and subsequent options

Prevention of prolonged pregnancy •Women with uncomplicated pregnancies should usually be offered induction of labour between 41and 42 weeks. -The exact timing should take into account the woman’s preferences and local circumstances. •When a vaginal examination is carried out to assess the cervix, the opportunity should be taken to offer the woman a membrane sweep.

Preterm prelabour rupture of membranes If this occurs after 34 weeks, the maternity team should discuss with the woman: •the risks to her and her baby •local availability of facilities before a decision is made about whether to induce labour, using vaginal PGE2.

Vaginal PGE2 Vaginal PGE2 is the preferred method of induction of labour, unless there are specific clinical reasons for not using it. It should be administered as gel, tablet or controlledrelease pessary. Costs may vary over time, and trusts/units should take this into consideration when prescribing vaginal PGE2.

Failed induction •If induction fails, healthcare professionals should discuss this with the woman and provide support. •The woman’s condition and the pregnancy in general should be fully reassessed. •Fetal wellbeing should be assessed using electronic fetal monitoring.

Failed induction The subsequent management options include: • a further attempt to induce labour (the timing should depend on the clinical situation and the woman’s wishes) • caesarean section.

Costs and savings The guideline on induction of labour is unlikely to result in a significant change in resource use in the NHS.

Discussion Does our appointment scheduling allow enough time to offer the recommended information to women? How can we improve women’s experience of induction of labour? What changes to shift patterns and booking appointments could we make to offer morning inductions?

Find out more Visit www.nice.org.uk/CG070 for: •Other guideline formats •Costing statement •Audit support