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October 2019: the review date for recommendation 1.3.1 was updated to show it had been amended in 2019 without an evidence review.
Excerpt
This guideline reviews the evidence for the care of women who present with signs and symptoms of preterm labour and those who are scheduled to have a preterm birth. It also reviews how preterm birth can be optimally diagnosed in symptomatic women, given that many women thought to be in preterm labour when clinically assessed will not deliver preterm. Optimal diagnosis can facilitate transfer to a place where appropriate neonatal intensive care can be provided, a strategy known to improve rates of survival for the baby. Additional areas that will be covered by the guidance (such as information needs for women who presents with signs and symptoms of preterm labour) are outlined in the guideline scope.
This guideline does not cover who should and should not have medically indicated preterm delivery, nor diagnostic or predictive tests in asymptomatic women. These issues have been reviewed in other NICE guidelines (Diabetes in Pregnancy, Hypertensive Disease in Pregnancy and Antenatal Care) or will be covered in the NICE guideline on High Risk Intrapartum Care.
Contents
- Introduction
- 1. Guideline summary
- 2. Guideline development methodology
- 3. Information and support
- 4. Prevention of preterm birth
- 5. Diagnosing preterm prelabour rupture of membranes (P-PROM)
- 6. Antenatal prophylactic antibiotics for women with P-PROM
- 7. Identifying infection in women with P-PROM
- 8. ‘Rescue’ cervical cerclage
- 9. Diagnosing preterm labour in women with intact membranes
- 10. Tocolysis
- 10.1. Introduction
- 10.2. Review question
- 10.3. Description of included evidence
- 10.4. Introduction to the new network meta-analysis
- 10.5. Introduction to pair-wise meta-analysis
- 10.6. Evidence profile
- 10.7. Evidence profiles for the pairwise comparisons
- 10.8. Evidence statements on NMA results
- 10.9. Evidence statements on pair-wise comparisons
- 10.10. Health economics profile
- 10.11. Evidence to recommendations
- 10.12. Recommendations
- 11. Maternal corticosteroids
- 12. Magnesium sulfate for neuroprotection
- 13. Fetal monitoring
- 14. Mode of birth
- 15. Timing of cord clamping for preterm babies
- 16. Health economics
- 16.1. What is the clinical effectiveness of prophylactic progesterone (vaginal or oral) in preventing preterm labour in pregnant women considered to be at risk of preterm labour and birth?
- 16.2. What is the diagnostic accuracy of the following (alone or in combination) in women with intact membranes to identify preterm labour leading to preterm birth
- 16.3. What is the clinical and cost effectiveness of magnesium sulfate given to women at high risk of giving birth preterm (defined as those suspected to be in preterm labour or diagnosed as being in preterm labour and those having planned preterm birth) for preventing cerebral palsy and other neurological disorders in babies born at different preterm gestations?
- 16.4. What is the clinical and cost effectiveness of tocolytics given to women with suspected or diagnosed preterm labour to improve outcomes
- 17. Glossary and abbreviations
- 18. References
- Appendices
Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.
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- Preterm Labour and BirthPreterm Labour and Birth
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