NICE NG207: Inducing Labour
Overview
NG207 covers information and decision-making for induction of labour (IOL), the circumstances in which induction should be offered, the methods used to induce labour, methods that are not recommended, assessment and monitoring during induction, pain relief, outpatient induction, and management of complications. It applies to pregnant women and people considering or undergoing induction and is intended for use alongside NICE's intrapartum care guideline (CG190).
Indications for Induction
- Prolonged/post-term pregnancy: Women with otherwise uncomplicated pregnancies should be given every opportunity to go into labour spontaneously (1.2.1). From 41+0 weeks onwards, clinicians should discuss the increased risks associated with continuing the pregnancy — including a higher likelihood of caesarean birth, neonatal unit admission, and stillbirth or neonatal death — and explain that induction from 41+0 weeks may reduce these risks, while balancing this against the woman's preferences for her birth experience (1.2.3–1.2.4).
- Prelabour rupture of membranes (PROM) at term (37+ weeks): Offer a choice between expectant management (up to around 24 hours) or immediate induction; if labour has not started spontaneously by about 24 hours, induction should be offered (1.2.13–1.2.14).
- Preterm prelabour rupture of membranes (before 37 weeks): Do not induce before 34+0 weeks unless there is an additional obstetric indication; expectant management is generally offered until 37+0 weeks, with the choice between expectant management and induction discussed in the 34+0 to 37+0 week window (1.2.10–1.2.11).
- Previous caesarean birth: Discuss the specific risks of induction after a prior caesarean, including emergency caesarean birth and uterine rupture; prostaglandins are used with particular caution in this group because of the increased rupture risk (1.2.17–1.2.19).
- Fetal growth restriction with confirmed fetal compromise: Induction is not recommended — caesarean birth should be offered instead (1.2.23).
- Suspected fetal macrosomia in diabetes: NG207 cross-refers to the NICE guideline on diabetes in pregnancy (1.2.25) rather than setting out separate induction criteria within NG207 itself.
Methods of Induction
- Membrane sweep: From 39+0 weeks onwards, membrane sweeping should be discussed and offered at antenatal visits, with consent obtained before the vaginal examination (1.3.1–1.3.2). It is intended to increase the chance of spontaneous labour and reduce the need for formal pharmacological or mechanical induction.
- Unfavourable cervix (Bishop score ≤6): Offer vaginal dinoprostone (tablet, gel, or slow-release system) or low-dose oral/vaginal misoprostol (1.3.7); mechanical methods such as a balloon catheter or osmotic dilators are an alternative option (1.3.8).
- Favourable cervix (Bishop score >6): Offer amniotomy combined with an intravenous oxytocin infusion (1.3.9).
- Outpatient induction: May be offered with vaginal dinoprostone preparations or mechanical methods in appropriately selected, low-risk women (1.6.1).
Fetal Monitoring During Induction
After administration of prostaglandins, fetal wellbeing should be assessed with cardiotocography (CTG); if the trace is normal, monitoring can subsequently switch to intermittent auscultation in women who otherwise remain low risk (1.5.3).
High-Yield Exam Points
- Uncomplicated pregnancy: offer/discuss induction from 41+0 weeks, not before, unless another indication exists.
- Term PROM: expectant management up to ~24 hours, then offer induction.
- Preterm PROM: no induction before 34+0 weeks without an added indication; expectant management typically continues to 37+0 weeks.
- Fetal growth restriction with confirmed compromise → caesarean, not induction.
- Bishop score ≤6 → prostaglandins or mechanical method; Bishop score >6 → amniotomy plus oxytocin.
- Membrane sweeping is offered from 39+0 weeks as an adjunct to reduce need for formal induction.
- CTG after prostaglandins, with option to step down to intermittent auscultation if the trace is normal and the woman remains low risk.
- Prostaglandins are used with particular caution after previous caesarean birth because of increased uterine rupture risk.
Reference
NICE NG207. Inducing Labour. National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/ng207
Source: National Institute for Health and Care Excellence (NICE) (4 November 2021)
Read the original on nice.org.uk
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