NICE recommends inducing woman in labour earlier than previously advised

pharmafile | May 25, 2021 | News story | Manufacturing and Production  

In new draft guidance published today NICE has recommended that inducing women in labour earlier than previously advised will make birth safer for them and their babies.

The updated advice strengthens previous recommendations in light of new evidence on induction timings.

The draft guideline update recommends that women with uncomplicated singleton pregnancies should be offered induction at 41 weeks and the induction should take place as soon as possible.

Previous guidelines advised induction between 41 and 42 weeks, and that women who had chosen not to be induced should be monitored after 42 weeks.

If women choose not to have induced labour their decision should be supported and their care options discussed with them.

Recent research which compared induction times and outcomes showed higher infant mortality after 42 weeks if the woman had not been induced.

Dr Paul Chrisp, Director of the Centre for Guidelines at NICE, said: “It’s vitally important that pregnant women faced with the possibility of induced labour are offered advice based on the latest evidence.

“By advising induced labour one week earlier, we can help ensure that women and babies are safer from harm and have the best possible outcomes during birth.”

Another update to the guidance involves recommendations around women who have experienced intrauterine fetal death. NICE identified an increased risk to women who experience this and who have previously had a caesarean birth, as they were more likely to suffer a uterine rupture. The draft guidance recommends that they should be advised of this risk when discussing birth options.

Previous advice stated that in these circumstances women should be offered pharmacological interventions to induce labour, namely mifepristone followed by a prostaglandin (dinoprostone or misoprostol) and careful monitoring.

However, the committee found no evidence about any pharmacological interventions in this group and noted that dinoprostone and misoprostol are now contraindicated for women who have a uterine scar.

Dr Chrisp said: “It’s tragic when a woman suffers intrauterine fetal death and we need to make sure they are fully supported. We also need to make sure they – and healthcare staff – are fully aware of the risks of different interventions and can make informed decisions accordingly.

“However, it’s clear that more research should be done to establish the safest and most effective way to induce labour in higher risk women who have experienced intrauterine fetal death, which is why we’ve made the recommendation to this effect.”

Lilly Subbotin

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