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Appendix A: Summary of Evidence from Surveillance. 2019 Surveillance of Intrapartum …

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NICE. National Institute for Health and Care Excellence. Appendix A: Summary of evidence from surveillance. 2019 surveillance of Intrapartum care for healthy women and babies (2014) NICE guideline CG190. 2019.

Place Of Birth
A systematic review of 15 studies (1)(n = 215,257) examined the proportion of transfers from a planned home birth setting to hospital and the reasons behind the transfers.Results indicated that the proportion of transfers varied from 9.9% to 31.9%, with the most common reason for transfer being dystocia(5.1-9.8%). Other reasons for transfer included fetal distress(1-3.6%) and postpartum haemorrhage(0-0.2%).

A meta-analysis(2)of 991 studies (n = 9,094,443) examined the association between smoking during pregnancy and placenta previa. Results indicated that smoking during pregnancy was significantly associated with an increased risk of placenta previa.

Intelligence gathering
No intelligence was identified for this section of the guideline.

Impact statement
New evidence was identified that highlighted the most common reasons for transfer to a hospital setting from a planned home birth setting were dystocia, fetal distress, and postpartum haemorrhage. The rates of transfers from this setting were found to be lower than those reported in table 3 in the guideline recommendations which states that the rates of transfer from home is approximately 45%. Table 5 in the guideline states that the most common reason for transfer from a home setting is delay in the first or second stage of labour (32.4%), followed by other factors which do include dystocia and postpartum haemorrhage. Respiratory problems are listed as a medical condition indicating increased risk leading to planned birth at an obstetric unit.

The new evidence suggests that rates of transfer from a home birth settingmay be lower than the guideline currently states, and that reasons for transfer might differ slightly from the information in the tables. However, the new evidence includes one systematic review including studies from outside the UK so the applicability of the findings may be lower than the Birthplace study used to inform guideline development. Furthermore, the authors were unable to perform a meta-analysis of the data so the ranges of the rates and reasons for transfer may be misleading. Therefore, due to the uncertainties around the data in the new evidence, it is unlikely that the guideline will be affected.

Results from a large meta-analysis indicate that smoking during pregnancy is significantly associated with an increased risk of placenta previa. Smoking is not currently listed inTable7as a factor indicating increased risk, suggesting planned birth in an obstetric unit.However, placenta previa is listed in this table, so women in this group are likely to be covered by the table already. Importantly, NICE guidelineCG62on antenatal care for uncomplicated pregnanciescovers assessment of smoking status and offering lifestyle advice to quit at an earlier point in pregnancy (before the intrapartum period).As NICE guideline CG62 and CG190 appear in a common interactive flowchart, guidance in this area is sufficient and no impact on the guideline is expected.

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