It covers healthy women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. As demonstrated in a randomized clinical trial, intrapartum antibiotic therapy for intraamniotic infection decreases the rate of neonatal bacteremia, pneumonia, and sepsis 26.Multivariate models of neonatal sepsis risk demonstrate the positive effect of intrapartum antibiotics on the risk of culture-confirmed neonatal infection 5 12. Care will not necessarily be given by the same midwife for the whole labour. Pulmonary oedema has been a significant cause of maternal death in eclampsia/pre-eclampsia, often associated with excess fluid administration. Generally it is preferable to describe specific signs in lieu of declaring fetal distress that include: . a) The number of women in labour that is progressing normally having amniotomy or oxytocin. For women at low risk of complications, amniotomy and oxytocin do not reduce the incidence of caesarean section, increase the incidence of spontaneous vaginal births or contribute to improved neonatal outcomes. Variation in practice should take into account such factors... Read More → Prenatal, intrapartum, and postpartum services performed at a free-standing birth center located in Maryland or a contiguous state Newborn’s initial medical exam in the hospital Child in State supervised care – initial medical exam by EPSDT certified provider The Royal Australian and New Zealand College of Obstetricians and Gynaecologists is a not-for-profit organisation dedicated to the establishment of high standards of practice in obstetrics and gynaecology and women’s health. is associated with an approximate risk of 40 in 1000 of a blood transfusion. These structured guidelines include stabilizing protocols and provisions for early transfer to an appropriate maternal level of care facility as indicated. Continue cardiotocography (unless it was started because of concerns arising from intermittent auscultation and there are no ongoing risk factors) and usual care, Talk to the woman and her birth companion(s) about what is happening, Correct any underlying causes, such as hypotension or uterine hyperstimulation, Perform a full set of maternal observations, Document a plan for reviewing the whole clinical picture and the cardiotocography findings, Talk to the woman and her birth companion(s) about what is happening and take her preferences into account, Exclude acute events (for example, cord prolapse, suspected placental abruption or suspected uterine rupture), If the cardiotocograph trace is still pathological after implementing conservative measures, obtain a further review by an obstetrician, offer digital scalp stimulation and document the outcome. Queensland clinical guidelines endorsed for use in all Queensland Health facilities. Randomised controlled trials comparing different dosage regimes for oxytocin and misoprostol, as well as … Access the Clinical Guidelines below.. A Policy is a set of statements or intentions that indicate the Women’s position on a particular issue.It guides conduct and decision making and must be … Recognize the normal postpartum events allow appropriate care, reassurance and early recognition of abnormal events. delivery of the placenta by maternal effort. People have the right to be involved in discussions and make informed decisions about their care, as described in. Recognize that labor is expected to progress in an orderly and predictable manner. Evidence of local arrangements to ensure that midwives and obstetricians encourage women to have skin-to-skin contact with their babies after the birth. 1.4 Initial assessment. Everything NICE has said on the care of healthy women and their babies during childbirth in an interactive flowchart. 11. Give ongoing consideration to the woman's emotional and psychological needs, including her desire for pain relief. Discuss the normal maternal physiologic changes of the postpartum period, Describe the components of normal postpartum care and the appropriate postpartum patient counseling. NICE has produced resources to help implement its guidance on: NICE has written information for the public on each of the following topics. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Clinical Guidelines, Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Proportion of women at low risk of complications whose labour is progressing normally who do not have amniotomy or oxytocin. The immediate postpartum period most often occurs in the hospital setting, where the majority of women remain for approximately 2 days after a vaginal delivery and 3-4 days after a cesarean delivery. ACOG defines PPH as cumulative blood loss ≥ 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process (including intrapartum) regardless of route of delivery. Numerator – The number in the denominator where the cord is clamped earlier than 1 minute after the birth. Current National Institute for Health and Care Excellence (NICE) antenatal and postnatal quality care standards both state women should have a named midwife 9. Students can find additional information in the Undergraduate Student Guide and Graduate & Professional Student Guide. Active management of the third stage involves a package of care comprising the following components: Physiological management of the third stage involves a package of care that includes the following components: Explain to the woman that active management : Explain to the woman that physiological management: (home, freestanding midwifery unit, alongside midwifery unit and obstetric unit), in accordance with current health and safety legislation (at the time of publication of NICE clinical guideline 139 [March 2012]): Health and Safety at Work Act 1974, Management of Health and Safety at Work Regulations 1999, Health and Safety Regulations 2002, Control of Substances Hazardous to Health Regulations 2002, Personal Protective Equipment Regulations 2002 and Health and Social Care Act 2008, (transfer between midwifery-led care and obstetric-led care – this may or may not involve transport from one location to another; women who are receiving midwifery-led care in an obstetric unit can have their care transferred to obstetric-led care without being moved), Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Acute coronary syndromes: early management, Acute coronary syndromes: secondary prevention and rehabilitation, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome myalgic encephalomyelitis, Diabetes and other endocrine, nutritional and metabolic conditions, Endocrine, nutritional and metabolic conditions, Lifestyle weight management services for overweight or obese adults, Lifestyle weight management services for overweight or obese children and young people, 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and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Intrapartum care – everything NICE says in an interactive flowchart, Care in established first stage of labour, Delay and complications in second stage of labour, Managing complications in the newborn baby, Cardiotocography and the initial assessment of a woman in labour. Proportion of women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes. Postpartum hemorrhage (PPH) is an obstetric emergency and is defined as a blood loss ≥ 1000 mL or blood loss presenting with signs or symptoms of hypovolemia within 24 hours of delivery. Concern would arise if, after delivery, the baby has a heartbeat below 60 beats/minute that is not getting faster. Effectiveness of Intrapartum Antibiotics for Meconium-Stained Amniotic Fluid [Medicine by the Numbers] ... Postpartum Care and Complications 10/15/2019 Postpartum Care: An … Cardiotocography is offered to women if intermittent auscultation indicates possible fetal heart rate abnormalities. By the end of the OB/GYN Clerkship Labor and Delivery component, the BUSM III student will be able to, Female Pelvic Medicine and Reconstructive Surgery, Reproductive Endocrinology and Infertility, Diagnostic Genetic Services and Genetic Counseling, Obstetrics Pre-Procedure Clinic Guidelines, List the signs and symptoms of normal labor, Describe the three stages of normal labor, Differentiate the methods of delivery with the indications and contraindications of each. Talk to the woman and her birth companion(s) about what is happening and take her preferences into account. The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. Best practice: Screen all pregnant women for GBS when in labour and provide intrapartum antibiotic prophylaxis at the Amniotic sac. postpartum: [ pōst-pahr´tum ] occurring after childbirth, with reference to the mother. Take into account the woman's preferences, any antenatal and intrapartum risk factors, the current wellbeing of the woman and unborn baby and the progress of labour. Fluid restriction is advisable to reduce the risk of fluid overload in the intrapartum and postpartum periods. During this time, women are recovering from their delivery and are beginning to care … 2 December 2014 Major update on publication of intrapartum care for healthy women and babies (NICE clinical guideline CG190). Women’s satisfaction with the support received to have skin-to-skin contact with their babies after the birth. 1.5 Ongoing assessment. •Postpartum Assessment and Care Evidence-Based Care Practices •Skin-to-Skin care •Delayed Cord Clamping •Early Initiation of Breastfeeding. Women have skin-to-skin contact with their babies after the birth. c) Maternal satisfaction and experience of care. Patient Summary Heavy bleeding after a baby is born (postpartum haemorrhage) is a complication of pregnancy that has the potential to be very serious, even resulting in death in rare cases. Women at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation have the cardiotocograph removed if the trace is normal for 20 minutes. Describe each of the following antepartum procedures and list the indications and contraindications for each: Describe each of the following intrapartum procedures and list the indications and contraindications for each, Identify the pertinent issues regarding vaginal birth after cesarean delivery. See definitions and abbreviations. Proportion of women with a record of having skin-to-skin contact with their babies after the birth. NICE intrapartum care Maternity and Neonatal disciplines are well supported. Maternal satisfaction and experience of care. Signs and symptoms. Denominator – The number of babies born where there is no concern about cord integrity or the baby’s heartbeat. Decreased movement felt by the mother; Meconium in the amniotic fluid ("meconium stained fluid"); Non-reassuring patterns seen on cardiotocography: . If there has been an acute event (for example, cord prolapse, suspected placental abruption or suspected uterine rupture), expedite the birth, Expedite the birth if the acute bradycardia persists for, If the fetal heart rate recovers at any time up to, deferred clamping and cutting of the cord. there is progressive cervical dilatation from 4 cm. Outcomes for women for each planned place of birth include rates of spontaneous vaginal birth, transfer to obstetric unit, obstetric intervention and delivering a baby with or without serious medical problems. Denominator – The number of babies born. Denominator – The number of women at low risk of complications whose labour is progressing normally. Denominator – The number of women in labour at low risk of complications who have cardiotocography because of concern arising from intermittent auscultation and who have a normal trace for 20 minutes. Remain with the woman in order to continue providing one-to-one support. Midwifery staffing levels as in the NICE guideline on. Complications of PROM. a) Proportion of women at low risk of complications with a recorded discussion at their antenatal booking appointment of their preferred choice of birth setting. 1.3 Latent first stage of labour. The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. Under the auspices of ACOG District II, multiple providers and hospitals … Ensure that the focus of care remains on the woman rather than the cardiotocography trace. One-to-one care will increase the likelihood of the woman having a ‘normal’ vaginal birth without interventions, and will contribute to reducing both the length of labour and the number of operative deliveries. This NICE Pathway covers the care of healthy women who go into labour at term (. controlled cord traction after signs of separation of the placenta. Maternal experience and satisfaction with place of birth. 20 February 2017 Recommendations on fetal monitoring in, 15 November 2016 Recommendation on continuity of care in. increased or decreased fetal heart rate (tachycardia and bradycardia), especially during and after a contraction 1.10 Monitoring during labour. A normal trace has the following normal/reassuring features: It should be noted that while variable decelerations of less than 90 minutes is a reassuring feature, the trace should not be removed at 20 minutes if these are present without further assessment. Numerator – The number in the denominator where there is a record of the woman having skin-to-skin contact with the baby. Denominator – the number of babies born where there is a concern about cord integrity or the baby’s heartbeat. Evidence of local arrangements to ensure that midwives and obstetricians do not clamp the cord earlier than 1 minute after the birth unless there is a concern about cord integrity or the baby’s heartbeat. This can lead to a cascade of interventions that may result in adverse birth outcomes. This sac will almost always rupture before the baby is born, though in … It is important that this happens as soon as possible, but timescales should be determined locally, depending on the setting and whether the baby and mother are stable. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives V4.0 International licence. Concerns would arise over cord integrity if the cord was damaged in any way, if it had snapped during delivery or if there was bleeding to the cord. Management of Suspected or Confirmed Intraamniotic Infection. ... the ability of the service to provide a safe level of care, and the woman's wishes. Numerator – The number in the denominator with a recorded discussion at their antenatal booking appointment about local birth outcomes. 27 February 2017 Intrapartum care (NICE quality standard 105) updated. 1.2 Care throughout labour. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. 10 February 2020 Episcissors-60 for mediolateral episiotomy (NICE medical technologies guidance 47) added to. Skin-to-skin contact with babies soon after birth has been shown to promote the initiation of breastfeeding and protect against the negative effects of mother–baby separation. Discuss fetal and maternal effects of oxytocin administration, Discuss strategies for emergency management in Obstetrics, List the normal physiologic and anatomic changes of the breast during the pregnancy and lactation, Recognize and treat common postpartum abnormalities of the breast, Provide the reasons why breast feeding should be encouraged, Identify commonly used medications which are appropriate and inappropriate to use while breast feeding. a) Evidence of local arrangements to provide women at low risk of complications with a choice of all 4 birth settings. no clamping of the cord until pulsation has stopped. Evidence of local arrangements to ensure that women at low risk of complications who are in labour that is progressing normally do not have amniotomy or oxytocin. Denominator – The number of women in established labour in a time period. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do 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. In addition, recommendations are included that address the care of women who start labour as 'low risk' but who go on to develop complications. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. Women at low risk of complications are not offered amniotomy or oxytocin if labour is progressing normally. b) Proportion of cords clamped earlier than 1 minute where there is a concern about cord integrity or the baby’s heartbeat. 9 December 2015 Intrapartum care (NICE quality standard 105) added. In the postnatal period this person is referred to as a named healthcare practitioner 10. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. Visit Back2BU for the latest updates and information on BU's response to COVID-19. All providers of intrapartum obstetrical care (physicians, nurses, midwives) should be required to commit to formal education in fetal health surveillance and maintain up-to-date competence with formal education review of both intermittent auscultation and electronic fetal monitoring every 2 years (II-B). The NICE Pathway is intended to cover the care of healthy women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. They should do so 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. Subject to Notice of rights. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should. b) Maternal satisfaction and experience of care. is associated with nausea and vomiting in about 50 in 1000 women, is associated with an approximate risk of 29 in 1000 of a haemorrhage of more than. Am J Obstet Gynecol . x Perinatal Mood and Anxiety Disorders (PMADs) are one of the most common complications of the perinatal period. © NICE 2021. Numerator – The number in the denominator where the cord is clamped after 1 minute after the birth. This statement has been removed. Women with known risk factors for PPH should only be delivered in a hospital with a blood It is the number one cause of maternal morbidity and mortality worldwide. Women at low risk of complications during labour and birth need information that is specific to their local or neighbouring area about safety and outcomes for women and babies in the different birth settings. postpartum pituitary necrosis necrosis of the pituitary during the postpartum period, resulting from an infarct; it is often associated with shock and excessive uterine bleeding during delivery, and leads to variable patterns of hypopituitarism. Our Clinical Guidelines present statements of best practice based on thorough evaluation of evidence. Clinicians must be aware of risk factors for PPH and should take these into account when counselling women about place of delivery. List the signs and symptoms of normal labor; Describe the three stages of normal labor; … Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, assess and reduce the environmental impact of implementing NICE recommendations, Intrapartum care for healthy women and babies, Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury, Ultrasound-guided catheterisation of the epidural space, Episcissors-60 for mediolateral episiotomy, Detecting, managing and monitoring haemostasis: viscoelastometric point-of-care testing (ROTEM, TEG and Sonoclot systems), Accuro for guiding epidural or spinal anaesthesia, Novii Wireless Patch System for maternal and fetal monitoring, AmnioSense for unexplained vaginal wetness in pregnancy, The Epidrum for aiding access to the epidural space, choosing place of birth resource for midwives, intrapartum care for healthy women and babies, safe midwifery staffing for maternity settings, Detecting, managing and monitoring haemostasis: viscoelastometric point‑of‑care testing (ROTEM, TEG and Sonoclot systems), Controlled cooling to treat newborn babies with brain injury caused by oxygen shortage during birth, Using ultrasound scanning to help place an epidural tube to give pain relief or an anaesthetic.