Quality standard

Quality statement 5: Corticosteroids for women between 24+0 and 33+6 weeks of pregnancy

Quality statement 5: Corticosteroids for women between 24+0 and 33+6 weeks of pregnancy

Quality statement

Women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have preterm prelabour rupture of membranes (P-PROM) are offered maternal corticosteroids.

Rationale

Giving corticosteroids to a woman before a preterm birth reduces the severity of lung disease of prematurity and of other associated complications for her baby. Maternal corticosteroids also have the potential to reduce the number of days that the baby needs to be on a ventilator.

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 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P-PROM are offered maternal corticosteroids.

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

a) Proportion of women between 24+0 and 33+6 weeks of pregnancy in suspected, diagnosed or established preterm labour who receive maternal corticosteroids.

Numerator – the number in the denominator who receive maternal corticosteroids.

Denominator – the number of women between 24+0 and 33+6 weeks of pregnancy in suspected, diagnosed or established preterm labour.

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

b) Proportion of women between 24+0 and 33+6 weeks of pregnancy having a planned preterm birth who receive maternal corticosteroids.

Numerator – the number in the denominator who receive maternal corticosteroids.

Denominator – the number of women between 24+0 and 33+6 weeks of pregnancy who are having a planned preterm birth.

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

c) Proportion of women between 24+0 and 33+6 weeks of pregnancy with P-PROM who receive maternal corticosteroids.

Numerator – the number in the denominator who receive maternal corticosteroids.

Denominator – the number of women between 24+0 and 33+6 weeks of pregnancy with P-PROM.

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) Ventilation.

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

b) 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.

c) 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.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P-PROM are offered maternal corticosteroids by healthcare professionals.

Healthcare professionals (such as obstetricians and midwives) offer maternal corticosteroids to women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P‑PROM.

Commissioners (clinical commissioning groups or integrated care systems) commission services that ensure that women between 24+0 and 33+6 weeks of pregnancy who are in suspected, diagnosed or established preterm labour, are having a planned preterm birth or have P-PROM are offered maternal corticosteroids.

Women over 24 weeks and under 34 weeks of pregnancy are offered corticosteroid injections to help their baby's lungs develop if:

  • they are in suspected preterm labour or

  • they are in diagnosed preterm labour (they have had a test that shows they are in labour) or

  • they are in established preterm labour or

  • they are having a planned preterm birth or

  • they have P-PROM – this is when a woman's waters break early but labour hasn't started.

Source guidance

Preterm labour and birth. NICE guideline NG25 (2015, updated 2022), recommendation 1.9.2

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]

Established preterm labour

A woman is in established preterm labour if she has progressive cervical dilation from 4 cm with regular contractions. [NICE's guideline on preterm labour and birth, terms used in this guideline]

Planned preterm birth

A planned birth before 37+0 weeks of pregnancy because of medical complications. [NICE's full guideline on preterm labour and birth]

Preterm prelabour rupture of membranes (P‑PROM)

A woman is described as having P‑PROM if she has ruptured membranes before 37+0 weeks of pregnancy but is not in established labour. [NICE's guideline on preterm labour and birth, terms used in this guideline]

Maternal corticosteroids

Corticosteroids (glucocorticosteroids) are anti-inflammatory medicines given to the woman (usually by intramuscular injection) which cross the placenta and accelerate fetal lung maturation.

In June 2022, this was an off-label use of bethamethasone and desamethasone. See NICE's information on prescribing medicines. [Adapted from NICE's full guideline on preterm labour and birth]