Quality standard
Quality statement 2: Prophylactic vaginal progesterone and prophylactic cervical cerclage
Quality statement 2: Prophylactic vaginal progesterone and prophylactic cervical cerclage
Quality statement
Women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage.
Rationale
Preterm birth causes significant neonatal morbidity and mortality, as well as long-term disability. Therefore, strategies for preventing preterm birth are important. Both prophylactic cervical cerclage and prophylactic vaginal progesterone are effective in preventing or delaying preterm birth in women with a short cervix and a history of spontaneous preterm birth (up to 34+0 weeks of pregnancy) or loss (from 16+0 weeks of pregnancy onwards). Which treatment is best for each woman will depend on her individual preferences and circumstances, and women should be given information as part of shared decision making.
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.
Structure
Evidence of local arrangements and written clinical protocols to ensure that women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service specifications and clinical protocols.
Process
Proportion of women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy who are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage.
Numerator – the number in the denominator who are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage.
Denominator – the number of women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Timing of labour and birth.
Data source: NHS Maternity Statistics include data from Hospital Episode Statistics (HES) on the number of 'delivery episodes' with a number of breakdowns including by method of onset of labour, delivery method and place of delivery.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage, with the choice of treatment depending on the woman's preferences and circumstances.
Healthcare professionals (such as obstetricians) offer women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage, with the choice of treatment depending on the woman's preferences and circumstances.
Commissioners (clinical commissioning groups or integrated care systems) commission services that ensure that women who have had a previous preterm birth or loss and have a cervical length of 25 mm or less measured between 16+0 and 24+0 weeks of pregnancy are offered a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage, with the choice of treatment depending on the woman's preferences and circumstances.
Women at increased risk of preterm labour in whom an ultrasound scan has shown that they have a short cervix are offered a treatment to stop the cervix (neck of the womb) opening early and so delay labour and birth. This could be either progesterone (a natural female sex hormone) inserted into the vagina or a stitch in the cervix, with the choice of treatment depending on the woman's preferences and circumstances.
Source guidance
Preterm labour and birth. NICE guideline NG25 (2015, updated 2022), recommendation 1.2.1
Definitions of terms used in this quality statement
Prophylactic vaginal progesterone
Progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth.
In August 2019, this was an off-label use of vaginal progesterone. See NICE's information on prescribing medicines. [NICE's full guideline on preterm labour and birth]
Prophylactic cervical cerclage
A treatment for cervical weakness (also termed cervical incompetence or insufficiency) to prevent preterm birth and miscarriage. [Adapted from NICE's full guideline on preterm labour and birth]