Quality standard

Quality statement 1: Intrapartum antibiotics

Quality statement 1: Intrapartum antibiotics

Quality statement

Pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection are offered intrapartum antibiotics and given the first dose within 1 hour of the decision to treat. [2014, updated 2024]

Rationale

Giving intrapartum antibiotics to pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection (for example, from group B streptococcus or because the pregnant woman or pregnant person may have chorioamnionitis, an infection in their womb) can prevent early-onset neonatal infection. The first dose should be given as soon as possible and within 1 hour of the decision to treat; this will be within 1 hour after the start of labour if the need for intrapartum antibiotics was identified during pregnancy, or within 1 hour of the need for antibiotics being identified if this is after labour has started. This is because intrapartum antibiotics are most effective when the baby has sufficient exposure to the antibiotic. The 1‑hour timescale has been derived from expert opinion and has been included to ensure the quality statement is easily measurable.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

a) Proportion of pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection who receive intrapartum antibiotics.

Numerator – the number in the denominator who receive intrapartum antibiotics.

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

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

b) Proportion of pregnant women and pregnant people receiving intrapartum antibiotics who are given them within 1 hour of the decision to treat.

Numerator – the number in the denominator whose intrapartum antibiotics are given within 1 hour of the decision to treat.

Denominator – the number of pregnant women and pregnant people who receive intrapartum antibiotics.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Rates of early-onset neonatal infection.

Data source: NHS Maternity Statistics include data from hospital episode statistics on the number of 'delivery episodes' where bacterial sepsis of newborn babies is recorded as a birth complication. Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (maternity services) ensure that systems are in place to enable intrapartum antibiotics to be offered to pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection and ensure the first dose is given as soon as possible and within 1 hour of the decision to treat. They ensure that systems are in place for antibiotics to be offered and given as soon as possible, and within 1 hour of infection being suspected, in the case of chorioamnionitis.

Healthcare professionals (for example, midwives and obstetricians) identify pregnant women and pregnant people whose babies may be at risk of early-onset neonatal infection. They offer intrapartum antibiotics to those pregnant women and pregnant people and, for those who choose to receive it, ensure that the first dose is given as soon as possible after labour starts and within 1 hour of the decision to treat. If the need for antibiotics is identified after labour has started, they are given as soon as possible and within 1 hour. Healthcare professionals offer and give antibiotics as soon as possible, and within 1 hour of infection being suspected, in the case of chorioamnionitis.

Commissioners ensure that maternity care providers have systems and protocols in place for healthcare professionals to offer intrapartum antibiotics to pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection, and that the first dose is given as soon as possible and within 1 hour of the decision to treat. They ensure that antibiotics are offered and given as soon as possible, and within 1 hour of infection being suspected, in the case of chorioamnionitis.

Pregnant women and pregnant people whose babies are at risk of early-onset neonatal infection are offered antibiotics in labour to help prevent their baby developing infection. They are given the first dose of antibiotics as soon as possible and within 1 hour after the start of labour. If the need for antibiotics is identified after labour has started, they should be given within 1 hour of the decision to treat. If healthcare professionals think that the pregnant woman or pregnant person may have an infection in their womb (chorioamnionitis), they will be offered antibiotics and, if accepted, these will be given as soon as possible and within 1 hour.

Source guidance

Neonatal infection: antibiotics for prevention and treatment. NICE guideline NG195 (2021), recommendations 1.2.1, 1.2.4 and expert opinion. The 1‑hour timescale has been derived from expert opinion and has been included to ensure the quality statement is easily measurable

Definitions of terms used in this quality statement

Babies who are at risk of early-onset neonatal infection

Babies are at risk of early-onset neonatal infection if the pregnant woman or pregnant person:

  • is in preterm labour, or

  • has group B streptococcal colonisation, bacteriuria or infection during the current pregnancy, or

  • has had group B streptococcal colonisation, bacteriuria or infection in a previous pregnancy, and has not had a negative test for group B streptococcus by enrichment culture or PCR on a rectovaginal swab sample collected between 35 and 37 weeks' gestation or 3 to 5 weeks before the anticipated delivery date in the current pregnancy, or

  • has had a previous baby with an invasive group B streptococcal infection, or

  • has a clinical diagnosis of chorioamnionitis.

[NICE's guideline on neonatal infection, recommendation 1.2.1]

Intrapartum antibiotics

These are antibiotics given throughout labour until the baby is born. [NICE's guideline on neonatal infection, recommendation 1.2.2]