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...
A single course of maternal antenatal corticosteroids (ACS) before
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...
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...
Women with one previous lower-segment caesarean section (LSCS) should be counselled about both planned VBAC and elective repeat caesarean section (ERCS)
Anaemia in pregnancy: Hb <110 g/l first trimester, <105 g/l
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...
Covers late intrauterine fetal death (IUFD) — death of a singleton fetus
Covers suspected preterm prelabour rupture of membranes (PPROM) from
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...
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...
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...
Ectopic pregnancy occurs in approximately 1 in 80 pregnancies
Epilepsy affects 0.5-1% of pregnancies; about 2,500 infants are born
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...
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...
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 (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...
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...
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 ...
Intrahepatic cholestasis of pregnancy (ICP), previously termed
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...
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...
Bladder pain syndrome (BPS) is a diagnosis of exclusion — there is no
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...
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 ...
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...
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...
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. ...
**Chronic hypertension**: hypertension present before 20 weeks gestation or pre-existing
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...
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...
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 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...
Supreme Court ruling that fundamentally changed consent law in the UK
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 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...
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 ...
**Low-lying placenta**: placental edge within 20mm of the internal cervical os but not covering it
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 (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...
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...
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 birth**: delivery before 37+0 weeks gestation
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...
**Primary PPH**: blood loss from the genital tract of 500ml or more within 24 hours of delivery
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...
This edition has been retired. The current guidance on this topic is
RCOG GTG 33 focused narrowly on the **long-term health consequences**
This edition has been retired. The current guidance on this topic is
This edition has been retired. The current guidance on this topic is
This edition has been retired. The current guidance on this topic is
This edition has been retired. The current guidance on this topic is
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 (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...
VTE remains a leading direct cause of maternal death in the UK
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 (SGA):** estimated fetal weight (EFW) or
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....
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. ...
**NVP (nausea and vomiting of pregnancy):** diagnosed when onset is
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.
All RhD-negative pregnant women should be offered routine antenatal anti-D prophylaxis (RAADP)
Obstetric anal sphincter injuries (OASIS) encompass third- and fourth-degree tears.
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).
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 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...
RCOG withdrew GTG 40 and now signposts clinicians to the Faculty of Sexual
RCOG withdrew this guideline and now directs clinicians to NICE NG23 for current
Non-infective vulval disease falls into three broad groups: inflammatory dermatoses, vulval pain syndromes (vulvodynia), and pre-malignant squamous intraepithelial lesions.
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