Presentation on theme: "Induction of labour Implementing NICE guidance 2008 NICE clinical guideline 70."— Presentation transcript:
Induction of labour Implementing 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 PGE 2 ) 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 womans 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 PGE 2.
Vaginal PGE 2 Vaginal PGE 2 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 PGE 2.
Failed induction If induction fails, healthcare professionals should discuss this with the woman and provide support. The womans 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 womans 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 womens experience of induction of labour? What changes to shift patterns and booking appointments could we make to offer morning inductions?
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