Induction guidelines: UK

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health, and the prevention and treatment of ill health. Their guidance is developed by a number of independent advisory groups made up of health professionals, those working in the NHS, patients, their carers and the public.

It’s important to point out that the NICE guidelines are just that; they’re guidelines or recommendations, not regulations NHS Trusts must follow.  Supposedly this allows for health professionals to also be guided by their knowledge and skill.

I read the following guideline because I wanted to know what the recommendations are for inductions here in the UK, particularly the reasons for inducing and when to induce. I also wondered if there would be any mention of misoprostol in particular. What follows are the most important points for me.

Clinical guideline CG70: Induction of labour (July 2008)
Updated and replaces the guideline from 2001

Options:

It’s suggested that women should be told most women go into labour spontaneously by 42 weeks. At their 38 week antenatal visit women should receive information about the risks of prolonged pregnancies (ie ones that are longer than 42 weeks) and told their options.

Induction, if the pregnancy is uncomplicated, should be offered between 41+0 and 42+0 weeks. Encouraging the decision to be made by the couple as well as to look at a variety of information sources, the woman needs to be supported and her decision respected regardless of what that is.

If she has declined an induction, from 42 weeks increased (at least twice-weekly) antenatal monitoring should be offered.

Induction:

The woman should be told that induced labour is likely to be more painful than spontaneous labour and informed of the pain relief options.

Vaginal prostaglandin E2 (PGE2) is the preferred method of induction of labour, unless there are specific clinical reasons for not using it (in particular, the risk of uterine hyperstimulation). It should be administered as a gel, tablet or controlled release pessary. Oral and intravenous PGE2 should not be used for induction.

When offering PGE2 for induction of labour, healthcare professionals should inform women about the associated risks of uterine hyperstimulation.

When contractions begin, fetal wellbeing should be continuously monitored electronically.

Misoprostol:

• misoprostol is not licensed for induction of labour in the UK

• if misoprostol is given orally, the dose should not exceed 50 micrograms

• higher doses are associated with higher rates of uterine hyperstimulation

• misoprostol 25 micrograms vaginal tablet is not superior to vaginal PGE2 for induction of labour

• when the cervix is unfavourable, doses above 25 micrograms are associated with higher rates of successful induction of labour but at the expense of higher rates of uterine hyperstimulation

• currently available preparations are 100 microgram and 200 microgram oral tablets; tablets must be cut or made into suspension to achieve lower doses (e.g. 25 micrograms or 50 micrograms), but uniform concentration and accurate drug delivery is not guaranteed.

Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death or in the context of a clinical trial.

Sorry, I just need to repeat this:

Misoprostol should only be offered as a method of induction of labour to women who have intrauterine fetal death or in the context of a clinical trial.

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