Induction of labour Implementing NICE guidance 2008 NICE clinical guideline 70.

Induction of labourImplementing 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 controlled-release 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.

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.

Failed induction

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

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