Quality statement 4: Tocolysis for women between 26+0 and 33+6 weeks of pregnancy | Preterm labour and birth | Quality standards

Quality statement

Women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis.

Rationale

For women in suspected preterm labour, tocolysis may delay the birth and reduce the risk of problems such as cerebral palsy and of neonatal death. Not all women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are currently offered this treatment. It is important that the potential benefits and risks of this treatment are discussed with the woman and her family members. Tocolysis is appropriate only under particular circumstances, and a range of factors need to be taken into account.

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 between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis.

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 between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour who receive tocolysis.

Numerator – the number in the denominator who receive tocolysis.

Denominator – the number of women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour.

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

a) Neonatal death.

Data source: The Office for National Statistics provides annual statistics on child and infant mortality in England and Wales.

b) Intraventricular haemorrhage.

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.

c) Incidence of neonatal sepsis.

Data source: NHS Maternity Statistics include data from Hospital Episode Statistics (HES) on the number of 'delivery episodes' where bacterial sepsis of newborn is recorded as a birth complication.

d) Use of antibiotics.

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.

e) Ventilation.

Data source: NHS Maternity Statistics include data on neonatal critical care.

What the quality statement means for different audiences

Service providers (such as secondary or tertiary care services) ensure that women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis as appropriate.

Healthcare professionals (such as midwives and obstetricians) offer tocolysis as appropriate to women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour.

Commissioners (clinical commissioning groups or integrated care systems) commission services that ensure that women between 26+0 and 33+6 weeks of pregnancy who have intact membranes and are in suspected or diagnosed preterm labour are offered tocolysis as appropriate.

Women who are more than 26 weeks but less than 34 weeks pregnant and in suspected or diagnosed preterm labour are offered tocolytics (medicines that slow down or stop labour) if these medicines are likely to help their baby. The benefits and risks of this treatment are explained to them.

Source guidance

Preterm labour and birth. NICE guideline NG25 (2015, updated 2022), recommendation 1.8.3

Definitions of terms used in this quality statement

Suspected preterm labour

A woman is in suspected preterm labour if she has reported symptoms of preterm labour and has had a clinical assessment (including a speculum or digital vaginal examination) that confirms the possibility of preterm labour but rules out established labour. [NICE's guideline on preterm labour and birth, terms used in this guideline]

Diagnosed preterm labour

A woman is in diagnosed preterm labour if she is in suspected preterm labour and has had a positive diagnostic test for preterm labour. [NICE's guideline on preterm labour and birth, terms used in this guideline]

Tocolysis

Drugs used to stop or delay the progress of labour. The NICE guideline recommends nifedipine as the first choice, or oxytocin receptor antagonists if nifedipine is contraindicated.

In November 2015, this was an off-label use of nifedipine. See NICE's information on prescribing medicines. [Adapted from NICE's full guideline on preterm labour and birth]