- Amniocentesis and Chorionic Villus Sampling
Amniocentesis and chorionic villus sampling (CVS) are invasive prenatal diagnostic procedures used to obtain fetal genetic material for karyotyping, microarray, or specific gene testing. They are offered after a highe...
- Antenatal Care
Full history: medical, obstetric, family, social, mental health
- Antenatal Corticosteroids to Reduce Neonatal Morbidity and Mortality
A single course of maternal antenatal corticosteroids (ACS) before
- Antepartum Haemorrhage
Antepartum haemorrhage (APH) is bleeding from or into the genital tract from 24+0 weeks of gestation until birth. It complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide...
- Assisted Vaginal Birth
In the UK, 10–15% of births are assisted vaginal births (AVB), rising to almost 1 in 3 nulliparous women. The guideline covers vacuum (ventouse) and forceps birth, non-rotational and rotational, and the governance con...
- Birth After Previous Caesarean Birth
Women with one previous lower-segment caesarean section (LSCS) should be counselled about both planned VBAC and elective repeat caesarean section (ERCS)
- Blood Transfusions in Obstetrics
Anaemia in pregnancy: Hb <110 g/l first trimester, <105 g/l
- Breaking Bad News Stations
1. **S — Setting**: private room, sit at same level, tissues available, introduce yourself, ask if they want anyone with them
- Caesarean Birth
| Category | Definition | Decision-to-Delivery Interval |
- Care After Non-Invasive Pre-Natal Testing
Non-invasive prenatal testing (NIPT), based on analysis of cell-free fetal DNA in maternal blood, is used within the NHS Fetal Anomaly Screening Programme as a second-tier test after a higher-chance combined or quadru...
- Care of Late Intrauterine Fetal Death and Stillbirth
Covers late intrauterine fetal death (IUFD) — death of a singleton fetus
- Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks
Covers suspected preterm prelabour rupture of membranes (PPROM) from
- Care of Women with Obesity in Pregnancy
Maternal obesity is common in the UK obstetric population — RCOG cites 21.3% of the antenatal population as obese, with fewer than half of pregnant women (47.3%) having a BMI in the normal range. The guideline's recom...
- Cervical Cerclage
Ambiguous older terms are replaced with indication-based names: **history-indicated** (prophylactic, based on history, placed 11–14 weeks in asymptomatic women), **ultrasound-indicated** (therapeutic, for cervical sho...
- Chickenpox in Pregnancy
Varicella zoster virus (VZV) causes chickenpox (primary infection) and shingles (reactivation). Around 90% of UK adults are seropositive, so primary infection in pregnancy is uncommon (~3/1000 pregnancies) but carries...
- Clinical Governance and Patient Safety
Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality and safety of their services. It has seven key components:
- Consent Stations
Material risk standard: disclose risks a reasonable person in the patient's position would consider significant
- Diabetes in Pregnancy
Aim for HbA1c <48 mmol/mol (6.5%) before conception
- Diagnosis and Management of Ectopic Pregnancy
Ectopic pregnancy occurs in approximately 1 in 80 pregnancies
- Ectopic Pregnancy and Miscarriage
**Threatened miscarriage**: vaginal bleeding with closed cervix, viable intrauterine pregnancy on USS
- Emergency Management Stations
Always begin with structured assessment:
- Endometriosis: Diagnosis and Management
Endometriosis: presence of endometrial-like tissue outside the uterus
- Epilepsy in Pregnancy
Epilepsy affects 0.5-1% of pregnancies; about 2,500 infants are born
- Ethics and Professional Dilemmas
1. **Autonomy**: respect the patient's right to make informed decisions about their own care; includes right to refuse treatment
- External Cephalic Version and Reducing the Incidence of Term Breech Presentation
This guideline covers external cephalic version (ECV) — manipulation of the fetus through the maternal abdomen to a cephalic presentation — as a means of preventing noncephalic presentation at delivery and reducing ca...
- Female Genital Mutilation and its Management
FGM refers to "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons." It has no health benefits, is a human rights vio...
- Fertility Problems: Assessment and Treatment
Offer initial investigations to couples who have not conceived after **1 year** of regular unprotected vaginal intercourse
- Genital Herpes in Pregnancy: Management
Neonatal herpes is rare but carries high morbidity/mortality. Most cases (75–85%) follow direct contact with infected genital secretions at birth; fewer follow postnatal exposure or, rarely, transplacental in-utero in...
- Gestational Trophoblastic Disease
Gestational trophoblastic disease (GTD) is a spectrum of disorders arising from abnormal proliferation of trophoblastic tissue, ranging from the premalignant conditions of complete and partial hydatidiform mole throug...
- HIV in Pregnancy: Management
Universal antenatal HIV screening (opt-out testing, repeated for high-prevalence areas or ongoing risk) combined with effective combination antiretroviral therapy (ART) has reduced UK mother-to-child (vertical) transm...
- Hypertension in Pregnancy
**Chronic hypertension**: present before 20 weeks or pre-existing diagnosis
- Identification and Management of Maternal Sepsis
Maternal sepsis is defined (WHO, 2017; adopted from Sepsis-3) as "a life-threatening condition resulting from organ dysfunction, resulting from infection during pregnancy, childbirth, post-abortion, or the postpartum ...
- International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (PCOS)
PCOS affects approximately **1 in 8 women** of reproductive age.
- Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy (ICP), previously termed
- Intrapartum Care for Healthy Women and Babies
Low-risk women should be offered choice of birth setting: home, freestanding midwifery unit (FMU), alongside midwifery unit (AMU), or obstetric unit
- Malaria in Pregnancy: Prevention
Malaria in pregnancy carries substantially higher maternal and fetal risk than in non-pregnant adults — increased risk of severe disease, anaemia, miscarriage, stillbirth, preterm birth and low birth weight. Preventio...
- Management of Beta Thalassaemia in Pregnancy
Thalassaemia **major**: women requiring more than 7 transfusion episodes/year. Thalassaemia **intermedia**: women requiring 7 or fewer transfusions/year, or none. Thalassaemia carriers (trait) do not require transfusi...
- Management of Bladder Pain Syndrome
Bladder pain syndrome (BPS) is a diagnosis of exclusion — there is no
- Management of Breech Presentation
This guideline addresses route of delivery and intrapartum technique for breech presentation at term and preterm. Antenatal care is not covered, and external cephalic version (ECV) is addressed separately in the compa...
- Management of Endometrial Hyperplasia
Endometrial hyperplasia is irregular proliferation of endometrial glands with an increased gland-to-stroma ratio, driven by unopposed oestrogen. It is the recognised precursor of endometrial cancer, with an estimated ...
- Management of Inherited Bleeding Disorders in Pregnancy
Women with inherited bleeding disorders are at increased risk of bleeding at miscarriage, termination, invasive antenatal procedures, and delivery, and require individualised, multidisciplinary care. The guideline cov...
- Management of Monochorionic Twin Pregnancy
Monochorionic (MC) placentation occurs in ~30% of twin pregnancies and carries near-universal vascular anastomoses connecting the two fetal circulations. This shared circulation is the root cause of complications uniq...
- Management of Ovarian Hyperstimulation Syndrome
OHSS is a complication of pharmacological ovarian stimulation for assisted reproductive technology (ART), driven by hCG/LH exposure of hyperstimulated ovaries, which triggers VEGF and other proinflammatory mediators. ...
- Management of Pre-eclampsia and Eclampsia
**Chronic hypertension**: hypertension present before 20 weeks gestation or pre-existing
- Management of Sickle Cell Disease in Pregnancy
Women with sickle cell disease (SCD) should be seen preconceptually by a sickle specialist for optimisation and screening for end-organ damage: echocardiography for pulmonary hypertension (tricuspid regurgitant jet ve...
- Management of Suspected Ovarian Masses in Premenopausal Women
In premenopausal women, almost all ovarian masses are benign. The risk of malignancy in a symptomatic cyst is approximately 1:1000, rising to 3:1000 by age 50. Around 10% of suspected "ovarian" masses are ultimately n...
- Management of Thyroid Disorders in Pregnancy
Oestrogen-driven rises in thyroxine-binding globulin, and first-trimester hCG (which weakly stimulates the TSH receptor), mean TSH falls and fT4/fT3 rise transiently in early pregnancy before returning toward pre-preg...
- Maternal Collapse in Pregnancy and the Puerperium
Maternal collapse is an acute event involving the cardiorespiratory and/or central nervous systems resulting in a reduced or absent conscious level (and potentially cardiac arrest and death), at any point in pregnancy...
- NHS Cervical Screening Programme: Overview
Women and people with a cervix aged **25-64** in England.
- NICE DG31: Non-Invasive Prenatal Testing for Chromosomal Abnormalities
Non-invasive prenatal testing (NIPT), also called cell-free DNA (cfDNA) screening, analyses fragments of placentally-derived cell-free fetal DNA circulating in maternal plasma. It can be performed from around 10 weeks...
- NICE NG123: Urinary Incontinence and Pelvic Organ Prolapse in Women: Management
NG123 divides urinary incontinence into three categories that determine the management pathway: **stress urinary incontinence** (leakage on effort/exertion), **urgency urinary incontinence/overactive bladder**, and **...
- NICE NG192: Caesarean Birth
NG192 covers the benefits and risks of caesarean birth versus vaginal birth, indications for planned caesarean birth, maternal request, procedural technique, and care before, during, and after caesarean birth, includi...
- NICE NG201: Antenatal Care
**Nulliparous women:** plan 10 routine antenatal appointments with a midwife or doctor (recommendation 1.1.7).
- NICE NG207: Inducing Labour
NG207 covers information and decision-making for induction of labour (IOL),
- NICE NG217: Epilepsies — Reproductive Health Considerations
NG217 ("Epilepsies in children, young people and adults") is an 11-section,
- NICE NG23: Menopause: Diagnosis and Management
In women aged 45 and over, identify perimenopause or menopause on the basis of symptoms alone, without laboratory tests, if they have vasomotor symptoms that have recently started together with a change in their menst...
- NICE NG25: Preterm Labour and Birth
A cervical length of **25 mm or less**, measured between **16+0 and 24+0
- NICE NG73: Endometriosis: Diagnosis and Management
NG73 covers the identification, investigation, and management of endometriosis in women and people presenting with suggestive symptoms, including organisation of care, referral pathways, and treatment options through ...
- NICE NG88: Heavy Menstrual Bleeding: Assessment and Management
Take a history covering the nature of the bleeding, associated symptoms (e.g. pain, pressure symptoms, intermenstrual or postcoital bleeding), impact on quality of life, and other factors that may affect treatment cho...
- NICE VTE in Pregnancy: No Dedicated Guideline Exists (General Summary)
NG211 is "Rehabilitation after traumatic injury" (published 18 January 2022) — it has no connection to venous thromboembolism or pregnancy. This file previously mislabelled it and has been corrected. There is no singl...
- Obtaining Valid Consent in Obstetrics and Gynaecology
Supreme Court ruling that fundamentally changed consent law in the UK
- Outpatient Hysteroscopy
Outpatient hysteroscopy (OPH) allows direct visualisation of the uterine cavity using miniaturised endoscopic equipment without intravenous sedation or general/regional anaesthesia in a formal theatre. The guideline's...
- Ovarian Cysts in Postmenopausal Women
Ovarian cysts are increasingly detected in postmenopausal women due to wider use of pelvic imaging. Reported incidence is roughly 5–17%. Most are benign, so the clinical goal is to reliably separate low-risk cysts (ma...
- Pelvic Inflammatory Disease
PID lacks a diagnostic gold standard, so clinical diagnosis is pragmatic: the positive predictive value of clinical assessment is only 65–90% against laparoscopy. Empirical antibiotic treatment should be started with ...
- Placenta Praevia and Placenta Accreta Spectrum
**Low-lying placenta**: placental edge within 20mm of the internal cervical os but not covering it
- Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management
The original combined No. 27 guideline is no longer maintained as a standalone document on the RCOG website — visiting its URL now redirects to the two component guidelines. Candidates should think of "GTG 27" as an u...
- Post-Hysterectomy Vaginal Vault Prolapse
Post-hysterectomy vaginal vault prolapse (PHVP) is descent of the apex of the vagina (the vaginal vault, or cuff scar after hysterectomy) — corresponding to **point C** on the Pelvic Organ Prolapse Quantification (POP...
- Postnatal Care
Individualised postnatal care plan developed before discharge
- Pregnancy and Breast Cancer
Breast cancer complicates roughly 1 in 3,000 pregnancies and is the most common cancer diagnosed in pregnancy. Pregnancy-associated breast cancer occurs in a younger population and is more often high-grade or oestroge...
- Premenstrual Syndrome: Management
PMS is defined as distressing physical, behavioural and psychological symptoms, in the absence of organic or underlying psychiatric disease, that regularly recur during the luteal phase of each menstrual cycle and res...
- Preterm Labour and Birth
**Preterm birth**: delivery before 37+0 weeks gestation
- Preventing Entry-Related Gynaecological Laparoscopic Injuries
Around 250,000 women undergo laparoscopic surgery in the UK annually. Most have no problems, but serious complications occur in roughly 1/1000 cases. Injuries occur characteristically during the **blind insertion of t...
- Prevention and Management of Postpartum Haemorrhage
**Primary PPH**: blood loss from the genital tract of 500ml or more within 24 hours of delivery
- Prevention of Early-Onset Group B Streptococcal Disease
Group B Streptococcus (GBS, *Streptococcus agalactiae*) colonises the bowel and genital tract of 20–40% of adults. Carriage in pregnancy is usually asymptomatic and intermittent. GBS is the most common cause of severe...
- RCOG Green-top Guideline No. 24: Endometriosis, Investigation and Management (Archived)
This edition has been retired. The current guidance on this topic is
- RCOG Green-top Guideline No. 33: Long-term Consequences of Polycystic Ovary Syndrome (Archived)
RCOG GTG 33 focused narrowly on the **long-term health consequences**
- RCOG Green-top Guideline No. 35: Urodynamic Stress Incontinence, Surgical Treatment (Archived)
This edition has been retired. The current guidance on this topic is
- RCOG Green-top Guideline No. 44: Preterm Prelabour Rupture of Membranes (Archived)
This edition has been retired. The current guidance on this topic is
- RCOG Green-top Guideline No. 60: Cervical Cerclage (Archived)
This edition has been retired. The current guidance on this topic is
- RCOG Green-top Guideline No. 7: Antenatal Corticosteroids to Reduce Neonatal Morbidity (Archived)
This edition has been retired. The current guidance on this topic is
- Recurrent Miscarriage
Recurrent miscarriage is defined as **three or more first-trimester miscarriages**, consistent with previous RCOG editions. Clinicians are encouraged to use clinical discretion and offer extensive evaluation after **t...
- Reduced Fetal Movements
Reduced fetal movements (RFM) is a common presenting complaint in the third trimester and one of the few maternally-reported warning signs of a fetus in jeopardy. The guideline exists because RFM is an independent mar...
- Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium
VTE remains a leading direct cause of maternal death in the UK
- Shoulder Dystocia
Shoulder dystocia is a vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the fetal shoulders after gentle downward traction has failed
- Small-for-Gestational-Age Fetus and a Growth Restricted Fetus, Investigation and Care
**Small-for-gestational-age (SGA):** estimated fetal weight (EFW) or
- The Diagnosis and Treatment of Malaria in Pregnancy
Malaria has no pathognomonic signs and can mimic a flu-like illness, so a travel history is essential in any pregnant woman with pyrexia of unknown origin. Misdiagnosis is a leading cause of preventable malaria death....
- The Initial Management of Chronic Pelvic Pain
Chronic pelvic pain (CPP) is intermittent or constant pain in the lower abdomen or pelvis of at least 6 months' duration, not occurring exclusively with menstruation or intercourse, and not associated with pregnancy. ...
- The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum
**NVP (nausea and vomiting of pregnancy):** diagnosed when onset is
- The Management of Women with Red Cell Antibodies during Pregnancy
Any clinically significant red cell antibody detected at booking or the routine 28-week screen should trigger identification and quantification, and referral for specialist input.
- The Use of Anti-D Immunoglobulin for Rh D Prophylaxis
All RhD-negative pregnant women should be offered routine antenatal anti-D prophylaxis (RAADP)
- Third- and Fourth-degree Perineal Tears, Management
Obstetric anal sphincter injuries (OASIS) encompass third- and fourth-degree tears.
- Thrombosis and Embolism during Pregnancy and the Puerperium: Acute Management
This guideline addresses the **immediate investigation and treatment of suspected acute VTE** (DVT or PE) in pregnancy and the puerperium. Risk-based prevention is covered separately in GTG No. 37a (thromboprophylaxis).
- Twin and Triplet Pregnancy
Must be determined at 11-13+6 week dating scan — most accurate time
- Umbilical Cord Prolapse
Cord prolapse is descent of the umbilical cord through the cervix, alongside (occult) or past (overt) the presenting part, with ruptured membranes. Reported incidence is approximately 1 in 500 pregnancies.
- Vasa Praevia: Diagnosis and Management
Vasa praevia occurs when fetal blood vessels run through the free membranes, unsupported by placental tissue or Wharton's jelly of the umbilical cord, and cross or run near the internal cervical os below the presentin...
- Venous Thromboembolism and Hormonal Contraception
RCOG withdrew GTG 40 and now signposts clinicians to the Faculty of Sexual
- Venous Thromboembolism and Hormone Replacement Therapy
RCOG withdrew this guideline and now directs clinicians to NICE NG23 for current
- Vulval Skin Disorders: Management
Non-infective vulval disease falls into three broad groups: inflammatory dermatoses, vulval pain syndromes (vulvodynia), and pre-malignant squamous intraepithelial lesions.