Tag Archives: labour

NIHR Signal: Waiting at home after inducing labour mechanically may be an option for low-risk women

Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000.

The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect.

Individual trials have indicated that catheter induction could be a safer alternative. This review is the first to gather the available evidence from 26 studies including 8,292 women that have reported the adverse event rate for catheters.

It supports balloon catheters as an induction method for low-risk pregnancies that could allow women to stay at home, benefiting the mother and saving NHS resources.

“This review provides encouraging evidence for the safety of balloon catheter cervical ripening in an outpatient setting. Adopting this technique for low-risk pregnancies could significantly improve women’s birth experience as well as economically benefiting the NHS. Is it time we reconsidered our induction methods?”

Sally Collins, Consultant Obstetrician & Subspecialist in Maternal & Fetal Medicine, Oxford University Hospitals NHS Foundation Trust; Associate Professor, Nuffield Department of Women’s & Reproductive Health, University of Oxford; Lecturer in Medical Sciences, St Anne’s College, University of Oxford

Diederen M, Gommers J, Wilkinson C, et al. Safety of the balloon catheter for cervical ripening in outpatient care: complications during the period from insertion to expulsion of a balloon catheter in the process of labour induction: a systematic review. BJOG. 2017. [Epub ahead of print].


Read the full signal here


WHO recommendations: intrapartum care for a positive childbirth experience

WHO intrapartum care
Image Source: WHO

The World Health Organization has published Intrapartum care for a positive childbirth experience.  This guideline brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care.  It highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies.  It includes 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.

Read the full guideline here

Read the RCM press release here

Maternity services monthly statistics March 2017, experimental statistics

Pregnant woman wikimedia
Image Source: NHS Photo Library

This is a report on NHS-funded maternity services in England for March 2017, using data submitted to the Maternity Services Data Set (MSDS). The MSDS has been developed to help achieve better outcomes of care for mothers, babies and children. The MSDS is a patient-level ‘secondary uses’ data set that re-uses clinical and operational data for purposes other than direct patient care, such as commissioning, clinical audit. It captures key information at each stage of the maternity service care pathway in NHS-funded maternity services, such as those provided by GP practices and hospitals. The data collected include mother’s demographics, booking appointments, admissions and re-admissions, screening tests, labour and delivery along with baby’s demographics, diagnoses and screening tests.

Read the statistics here 

NIHR Signal: Computerised interpretation of fetal heart rate during labour does not improve outcomes

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Using a computerised decision-support system to interpret the outputs of continuous electronic fetal monitoring during labour does not show any advantages over clinicians interpreting the outputs themselves.  This is the first trial to assess decision support of this kind.

In this large NIHR-funded trial, rates of poor neonatal outcomes, caesarean sections and assisted deliveries were not affected by whether clinicians were alerted to potential problems by the decision-support system or by their own interpretation of the data. Developmental outcomes at two years of age were not affected either.

The system used in the trial only looked at fetal heart rate patterns, and didn’t use other data about the labour (which may affect how a clinician manages the labour). This suggests that maternity units should focus on other ways of improving recognition of problems and decision making when they are detected rather than investing in such decision-support systems at this time.

Read the full report here




NIHR Signal: Induction of labour may be considered in pregnant women with a large baby

Image Source: NIHR

Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby.

This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting.

Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would need to be studied to be confident in these findings. When mothers were not induced babies were larger and born about a week later than if they were induced. They did suffer from more fractures, which can be a complication of delivering a larger baby.

Current guidance recommends only offering induction at 41 or 42 weeks in otherwise healthy women who have a larger than average baby.

This analysis suggests that earlier induction is likely to be safe and may be an option for women to consider.

Read the whole review here

NIHR Signal: Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection

Image Source: Wikimedia

Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks. The procedure was started within 24 hours and was compared to waiting for labour to start on its own.

Waters breaking at full term without the onset of labour is called pre-labour rupture of membranes. This can increase risks of maternal and neonatal infection and the need for caesarean section. As most women deliver spontaneously within a day, NICE recommend that women are offered an informed choice of either induction 24 hours after premature rupture of membranes or to watch and wait.

This updated Cochrane review included new evidence and suggests that induction before 24 hours may reduce infections without increasing caesarean sections, but there remains some uncertainty. This is due to low study quality, lack of longer term outcomes, and too few participants in trials to compare the numbers of any rare serious events.

These findings may help inform shared decisions about induction by providing more information to help women understand the risks.

Read the full Signal here

Management of Breech Presentation (RCOG Green-top Guideline No. 20b)

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This guideline provides up-to-date information on methods of delivery for women with breech presentation, this is the fourth edition of this guideline, first published in 1999 and revised in 2001 and 2006 under the same title.

The aim of this guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. Information regarding external cephalic version is the topic of the separate Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20a External Cephalic Version and Reducing the Incidence of Term Breech Presentation.

To access the full guideline click here