Green-top Guideline No. 26 Assisted Vaginal Birth

The aim of this guideline is to provide evidence-based recommendations on the use of antenatal corticosteroids in women at risk of preterm birth or undergoing caesarean birth at term.

1:  Key Recommendations (00:50)
2: Background and Scope (03:46 )
3: Identification and Assessment of Evidence (06:27)
4: The Benefits of Antenatal Corticosteroids (07:30)
4.1: What are the benefits of corticosteroids in preterm labour and birth (07:35)
4.2 What are the benefits of corticosteroids in planned caesarean birth at term (10:04)
Table 1: Risks and benefits of antenatal corticosteroids to be discussed and offered (16:46)
5: At what gestation should antenatal corticosteroids be discussed and offered (27:03)
6: In what particular circumstances would antenatal corticosteroids be discussed with and offered to women? (34:43)
6.1: Multiple pregnancy (34:54)
6.2 Women with diabetes mellitus (39:03)
6.3 Pregnancies complicated by fetal growth restriction, pre-eclampsia or antepartum haemorrhage (43:11)
6.4. Preterm, prelabour rupture of membranes (PPROM) (51:17)
7: What is the optimum dose and route of administration for a course of antenatal corticosteroids? (55:46)
Betamethasone (58:44 )
Dexamethasone (1:01:00)
8: How long after administration is a course of antenatal corticosteroids most effective? (1:05:40)
9: What are the risks associated with the administration of antenatal corticosteroids? (1:17:50)
9.1: What are the risks to the woman? (1:19:00)
9.2: What are the risks to the baby? (1:20:53)
10 - What are the contraindications to the use of antenatal corticosteroids? (1:31:44 )
11 - In what circumstances should an antenatal course of corticosteroids be repeated? (1:33:31)
12. Recommendations for future research (1:37:21)
13. Auditable topics (1:38:37)
Closing Statement (1:39:52)

Green-top Guideline no. 74 Antenatal corticosteroids to reduce neonatal morbidity and mortality

MP3 Audio Version of Green-top Guideline No. 75, Cervical Cerclage, published February 2022

The purpose of this guideline is to review the literature and provide evidence-based guidance on the use of cerclage in women at risk of preterm birth and second trimester loss.

1. Key recommendations (0:35)
2. Background and scope (03:03)
3. Identification and assessment of evidence (05:35)
4. Definitions (07:30)
5. History-indicated cerclage (11:14)
6. Ultrasound-indicated cerclage (16:54)
6.1. When should an ultrasound-indicated cerclage be offered? (16:58)
6.1.1 Women with a singleton pregnancy and a history of spontaneous second trimester loss or preterm birth (19:45)
6.2. Who should be offered serial sonographic surveillance with a view to ultrasound-indicated cerclage? (24:19)
7. Can cervical cerclage be recommended in any other groups of women considered at increased risk of preterm birth (29:50)
7.1. Multiple pregnancy (30:00)
7.2. Cervical surgery, trauma and uterine abnormalities (35:57)
7.3. Women with raised BMI (43:43)
8. Transabdominal cerclage (45:09)
8.1. When should a transabdominal cerclage be considered? (45:14)
8.2. Should a transabdominal cerclage be performed laparoscopically? (50:06)
8.3. How should women who experience delayed miscarriage or fetal death be cared for? (53:08)
9. Emergency cerclage (55:19)
9.1. When should a rescue cerclage be discussed and considered? (55.22)
9.2. What are the contraindications to cerclage insertion? (1:00:39)
9.3. What information should be given to women before cerclage insertion? (1:01:28)
10. Pre-operative management (1:08:00)
10.1. What investigations should be performed before insertion of cervical cerclage? (1:08:04)
10.2. Should amniocentesis to detect infection be performed before rescue or ultrasound-indicated cerclage? (1:10:53)
10.2.1. Is amnioreduction before emergency cerclage recommended? (1:14:23)
10.2.2. Should a latency period be observed between presentation and insertion of a rescue or ultrasound-indicated cerclage? (1:15:20)
10.2.3. Should routine genital tract screening for infection be carried out before cerclage insertion? (1:16:17)
11. Operative issues (1:17:35)
11.1. Should perioperative tocolysis be used for insertion of cerclage? (1:17:39)
11.2. Should perioperative antibiotics be given? (1:19:11)
11.3. What method of anaesthesia should be employed for the insertion of cerclage? (1:20:31)
11.4. Can cerclage be performed as a day-case procedure? (1:21:53)
11.5. Which technique and material should be used? (1:22:58)
12. Adjuvant management (1:28:53)
12.1. Bed rest (1:28:56)
12.2. Sexual intercourse (1:30:36)
12.3. Is there a role for post-cerclage serial sonographic surveillance of cervical length? (1:31:15)
12.4. Is fetal fibronectin testing useful following insertion of a cervical cerclage? (1:35:07)
12.5. Should women receive supplement progesterone following cerclage? (1:37:38)
12.6. Should women be offered Arabin pessary or progesterone instead of cerclage? (1:40:44)
13. When should the cerclage be removed? (1:44:39)
13.1. Should the cerclage be removed following PPROM? (1:47:30)
14. Recommendations for future research (1:50:28)
15. Suggested audit topics (1:51:25)
Closing statement (1:52:05)

Green-top Guideline No. 75 Cervical Cerclage

The RCOG podcast discusses living with fibroids. This condition affects 2 in 3 women, and, for some people they can really impact their lives. Dr Karen Joash discusses diagnosis, treatment and impact with Gochi Nwulu about living with this painful condition

RCOG Podcast – Episode 1: Fibroids

This information is for you if you wish to know more about diabetes that develops in pregnancy or if you have been offered testing for gestational diabetes.

It may also be helpful if you are a partner, relative or friend of someone who is in this situation.

Gestational Diabetes patient information

This information is for you if you have been told you may have endometriosis.

Links to further information are available on the RCOG website: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/endometriosis/

Endometriosis

This information is for you if you have been diagnosed with intrahepatic cholestasis of pregnancy (ICP), also known as obstetric cholestasis.

Links to further information are available on the RCOG website: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/intrahepatic-cholestasis-of-pregnancy/

Intrahepatic cholestasis of pregnancy (ICP)

This information is for you if you have pelvic organ prolapse and want to know more about it.

Links to further information are available on the RCOG website: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-organ-prolapse/

Pelvic organ prolapse

Assessments- A Trainee’s Perspective - Hannah Pierce

In our first episode the surgical skills fellows (Hannah Pierce & Naomi Harvey) talk to RCOG president, Ranee Thakar, and RCOG Vice-president for education, Ian Scudamore, on how the surgical skills project came to be and their own personal experiences of surgical skills training. The following bitesize episodes will do a deeper dive into each of the five chapters of the surgical skills interim report. Highlighting the key findings and generating conversation on some of the potential solutions to be taken forward in the next phase of the project

Episode 1: Knot to be missed: the RCOG surgical skills podcast - introduction

Episode 6: Knot to be missed: the RCOG surgical skills podcast - investing in the educators

In this episode, we discuss the fourth focus of the Surgical Skills project- Lifelong learning - and what we will be working on in the next phase of the project. 

New consultants and specialists often face the challenge of continuing their surgical skills acquisition in an environment where surgical opportunities may belimited by clinical responsibilities, rota pressures and increasing patient demands. Protected time and support are required for ongoing surgical skills maintenance and development. The next phase of the project will explore the role of fellowships.

Episode 5: Knot to be missed: the RCOG surgical skills podcast - lifelong learning

Episode 3: Knot to be missed: the RCOG surgical skills podcast - simulation and virtual learning

Our future workforce faces significant challenges in meeting the demands of an evolving healthcare landscape and the increasing complexity of patient needs. We must be strategic in supporting our workforce to match changing trends bу developing strong progressive career support for each resident doctor and ensuring we proactively develop a workforce capable of managing increased surgical complexity. 

In this episode, we discuss the first focus of the Surgical Skills project- Workforce of the future- and what we will be working on in the next phase of the project.

Episode 2: Knot to be missed: the RCOG surgical skills podcast - workforce of the future

BTA birth story - Jacqueline P2

Long gynaecology waiting lists, workforce shortages and the increasing complexity of surgeries have limited residents' exposure to surgical skills practice and training. We need to reprioritise surgical training through earlier focus on endoscopic training. by increasing adaptability in training and through investment in innovative technologies that support residents in accessing training opportunities. Simulation training has become a vital tool for surgical skills acquisition, providing a safe, controlled environment where doctors can practice procedures without risking patient safety. We will examine how we can embed simulation training into the RCOG curriculum and will establish a Simulation Working Group to ensure equal access to training. 

In this episode, we discuss the third focus of the Surgical Skills project- Re-prioritising surgical training - and what we will be working on in the next phase of the project.

Episode 4: Knot to be missed - The RCOG Surgical Skills Podcast - Reprioritising surgical training

Episode 7: Knot to be missed: the RCOG surgical skills podcast - laparoscopic simulation training

In this episode of Knot to be Missed: the RCOG Surgical Skills Podcast, hosts Hannah Pierce and Naomi Harvey are joined by Miss Nahid Gul, a leading consultant in gynaecological pelvic laparoscopic and robotic surgery. Together, they explore Miss Gul’s inspiring career journey—from her early days in obstetrics and gynaecology to her pioneering work in minimally invasive and robotic surgery. With insights into training, mentorship, and the evolving future of surgical practice in the UK, this conversation offers a compelling look at innovation, leadership, and the transformative potential of technology in women's health.

Episode 8: Knot to be Missed: RCOG surgical skills podcast: The rise of the robot

Episode 9: Knot to be Missed: RCOG surgical skills podcast: serving up the future of training

Birth Options After Previous Caesarean Section

Ectopic pregnancy

Acute pelvic inflammatory disease

Heavy bleeding after birth (post partum haemorrhage)

Treatment for symptoms of the menopause

This guideline comprises recommendations relating to the diagnosis, assessment, care and timing of birth of women presenting with suspected PPROM from 24+0 to 36+6 weeks of gestation. It also addresses care in a subsequent pregnancy.

1.  Key recommendations (01:07)

2.  Background and scope (03:35)

3.  Identification and assessment of evidence (04:45)

4. Diagnosis (05:27)

4.1 How is the diagnosis of PPROM made? (05:30)

5.  Assessment (10:54)

5.1  What is required antenatally to identify infection? (10:58)

5.2  Should neonatologists be included in the woman's care? (15:10)

6.  Management (16:58)

6.1  Should antibiotics be given? (17:00)

6.2  What is the role of antenatal corticosteroids? (20:09)

6.3  What is the role of magnesium sulfate for neuroprotection of the baby? (25:30)

6.4  Should tocolytic agents be used? (28:17)

6.5  Can women be monitored at home? (30:22)

6.6  Is there a role for amnioinfusion in PPROM? (35:35)

6.7  Should women with PPROM be offered emotional support? (37:34)

7.  Birth (39:02)

7.1  When is the appropriate time to deliver the baby? (39:05)

8.  Care in a subsequent pregnancy following PPROM (44:26)

8.1  Who should care for a the woman in a subsequent pregnancy? (44:32)

9.  Recommendations for future research (46:45)

10.  Auditable topics (47:49)

Disclosures of interest (49:18)

Funding (49:35)

Supporting information (50:13)

References (51:03)

GTG 73: Care of Women Presenting with Suspected PPROM from 24+0 Weeks of Gestation

This information is for you if you have been diagnosed with molar pregnancy or another type of gestational trophoblastic disease (GTD). Molar pregnancy is one of a number of different conditions that are called gestational trophoblastic disease (GTD). These rare conditions happen when a pregnancy does not develop normally from the very beginning.

This information may also be helpful if you are a partner, relative or friend of someone in this situation.

Molar Pregnancy And Gestational Trophoblastic Disease Audio

Evidence based information for the public from the Royal College of Obstetricians & Gynaecologists.

RCOG

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