National Institute for Health and Care Excellence Draft for consultation Intrapartum care for women with existing medical conditions or obstetric complications and their babies [D] Evidence reviews for asthma NICE guideline <TBC at publication> Evidence reviews for women at high risk of adverse outcomes for themselves and/or their baby because of existing maternal medical conditions September 2018 Draft for consultation Developed by the National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists DRAFT FOR CONSULTATION Disclaimer The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties. NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn. Copyright © NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: DRAFT FOR CONSULTATION DRAFT FOR CONSULTATION Contents Contents Intrapartum care for women with asthma .................................................................... 7 Intrapartum care for women with asthma – analgesia ................................................ 8 Review question ....................................................................................................... 8 Introduction ..................................................................................................... 8 Summary of the protocol ................................................................................. 8 Clinical evidence ............................................................................................. 9 Summary of clinical studies included in the evidence review ........................... 9 Quality assessment of clinical studies included in the evidence review ........... 9 Economic evidence ......................................................................................... 9 Summary of studies included in the economic evidence review ....................... 9 Economic model .............................................................................................. 9 Evidence statements ....................................................................................... 9 Recommendations ........................................................................................ 10 Rationale and impact ..................................................................................... 10 The committee’s discussion of the evidence .................................................. 10 Intrapartum care for women with asthma – prostaglandins ..................................... 13 Review question ..................................................................................................... 13 Introduction ................................................................................................... 13 Summary of the protocol ............................................................................... 13 Clinical evidence ........................................................................................... 14 Summary of clinical studies included in the evidence review ......................... 15 Quality assessment of clinical studies included in the evidence review ......... 16 Economic evidence ....................................................................................... 17 Summary of studies included in the economic evidence review ..................... 17 Economic model ............................................................................................ 17 Evidence statements ..................................................................................... 17 Recommendations ........................................................................................ 18 Rationale and impact ..................................................................................... 18 The committee’s discussion of the evidence .................................................. 19 References ................................................................................................................... 21 Appendices .................................................................................................................. 22 Appendix A – Review protocols .............................................................................. 22 Intrapartum care for women with asthma – analgesia .................................... 22 Intrapartum care for women with asthma – prostaglandins ............................ 27 Appendix B – Literature search strategies .............................................................. 34 Intrapartum care for women with asthma – analgesia .................................... 34 Intrapartum care for women with asthma – prostaglandins ............................ 43 5 DRAFT FOR CONSULTATION Contents Appendix C – Clinical evidence study selection ...................................................... 51 Intrapartum care for women with asthma – analgesia .................................... 51 Intrapartum care for women with asthma – prostaglandins ............................ 52 Appendix D – Excluded studies .............................................................................. 53 Intrapartum care for women with asthma – analgesia .................................... 53 Intrapartum care for women with asthma – prostaglandins ............................ 54 Appendix E – Clinical evidence tables .................................................................... 59 Intrapartum care for women with asthma – analgesia .................................... 59 Intrapartum care for women with asthma – prostaglandins ............................ 59 Appendix F – Forest plots ....................................................................................... 66 Intrapartum care for women with asthma – analgesia .................................... 66 Intrapartum care for women with asthma – prostaglandins ............................ 66 Appendix G – GRADE tables .................................................................................. 67 Intrapartum care for women with asthma – analgesia .................................... 67 Intrapartum care for women with asthma – prostaglandins ............................ 67 Appendix H – Economic evidence study selection .................................................. 68 Intrapartum care for women with asthma – analgesia .................................... 68 Intrapartum care for women with asthma – prostaglandins ............................ 68 Appendix I – Economic evidence tables ................................................................. 68 Intrapartum care for women with asthma – analgesia .................................... 68 Intrapartum care for women with asthma – prostaglandins ............................ 68 Appendix J – Health economic evidence profiles .................................................... 68 Intrapartum care for women with asthma – analgesia .................................... 68 Intrapartum care for women with asthma – prostaglandins ............................ 68 Appendix K – Health economic analysis ................................................................. 68 Intrapartum care for women with asthma – analgesia .................................... 68 Intrapartum care for women with asthma – prostaglandins ............................ 68 Appendix L – Research recommendations ............................................................. 69 Intrapartum care for women with asthma – analgesia .................................... 69 Intrapartum care for women with asthma – prostaglandins ............................ 69 6 DRAFT FOR CONSULTATION Intrapartum care for women with existing medical conditions or obstetric complications and their babies 1 Intrapartum care for women with asthma 2 This evidence report contains information on 2 reviews relating to intrapartum care for 3 women with asthma. 4 What are the risks and benefits of central neuraxial analgesia compared with systemic 5 analgesia, inhaled analgesia or no analgesia for women with asthma in labour? 6 What is the safety of drugs commonly used in labour in women with difficult asthma, 7 including prostaglandins for inducing labour and prostaglandins and other uterotonics for 8 treating postpartum haemorrhage?