Preterm labour: summary of NICE guidanceBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6283 (Published 23 November 2015) Cite this as: BMJ 2015;351:h6283
- Grammati Sarri, senior research fellow and guideline lead1,
- Melanie Davies, clinical director, consultant obstetrician and gynaecologist12,
- Maryam Gholitabar, research fellow1,
- Jane E Norman, chair of Guideline Development Group, professor of maternal and fetal health and director of centre3
- on behalf of the Guideline Development Group
- 1National Collaborating Centre for Women’s and Children’s Health, Royal College of Obstetricians and Gynaecologists, London, UK
- 2University College London Hospitals
- 3Tommy’s Centre for Maternal and Fetal Health, University of Edinburgh MRC Centre for Reproductive Health, Queen’s Medical Research Institute, Edinburgh, UK
- Correspondence to: G Sarri
What you need to know
To prevent preterm birth, offer a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage to women with
- a history of spontaneous preterm birth or mid-trimester loss between 16+0 and 34+0 weeks of pregnancy and
- a transvaginal ultrasound scan between 16+0 and 24+0 weeks of pregnancy, showing a cervical length of <25 mm.
To diagnose preterm labour
- consider transvaginal ultrasound measurement of cervical length to determine likelihood of birth within 48 hours for women who are ≥30+0 weeks pregnant and are in suspected preterm labour. If cervical length is >15 mm, explain that she is unlikely to be in preterm labour.
To treat preterm labour
- offer tocolysis, corticosteroids, or magnesium sulfate to women in preterm labour, including those with a cervical length of <15 mm, depending on gestation and clinical circumstances.
Preterm birth is the single biggest cause of neonatal mortality and morbidity in the UK, affecting over 52 000 babies (around 7.3% of live births) in England and Wales in 2012.1 About 75% of women delivering preterm do so after preterm labour,2 which is sometimes preceded by preterm prelabour membrane rupture.2 A “cause” for preterm labour is not always found, but it may be associated with infection. In other cases, preterm birth may result from elective delivery.
Babies born preterm have high rates of mortality, with the risk of mortality being inversely proportional to gestational age at birth.3 Babies who survive have increased rates of disability.3
This article summarises the most recent recommendations on the prevention, diagnosis, and management of preterm labour from the National Institute for Health and Care Excellence (NICE).4
What’s new in this guidance
Do not use diagnostic tests for preterm labour for symptomatic women who are <30+0 weeks pregnant, but treat them as appropriate
Use cervical length …