RCOG

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)

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)

This guideline sets a series of evidence-based standards to ensure a high level and consistency of practice in the provision and performance of amniocentesis and chorionic villus sampling (CVS).

1. Key recommendations (00:34)

2. Aim (02:17)

3. Background (02:52)

4. Identification and assessment of evidence (05:36)

5. How should care be organised in providing amniocentesis and CVS? (6:38)

6. What are the additional risks associated with invasive testing? (09:44)

6.1 What is the additional risk of miscarriage associated with amniocentesis and CVS? (09:51)

6.2 What are the additional risks associated with invasive testing? (23:19)

7. At what gestation should amniocentesis and CVS be carried out? (24:24)

7.1 At what gestation should amniocentesis be carried out? (24:32)

7.2 When should CVS be carried out? (27:24)

8. What are the considerations when performing amniocentesis or CVS for multiple pregnancy? (29:30)

9. What is the role of third trimester amniocentesis? (37:44)

10. What are the risks of mother to child transmission of infection? (40:33)

11. Recommendations for future research (47:24)

12. Auditable topics (47:44)

13. Useful links and support groups (48:57)

Disclosures of interest (50:33)

Funding (50:49)

References (51:30)

Scientific Impact Paper No. 63 Elective Egg Freezing For Non-Medical Reasons by Royal College of Obstetricians and Gynaecologists

Green-top Guideline No. 26 Assisted Vaginal Birth by Royal College of Obstetricians and Gynaecologists

00:00:28 Executive Summary

00:16:11 1. Purpose and Scope

00:17:02 2. Introduction and background epidemiology

00:21:57 3. Identification and assessment of evidence

00:23:44 4. Clinical issues

00:23:47 4.1. Can women at risk of collapse be identified early?

00:29:15 4.2. What are the causes of maternal collapse?

00:31:13 4.2.1. Haemorrhage

00:32:40 4.4.2. Thromboembolism

00:33:21 4.2.3. Amniotic fluid embolism

00:36:03 4.2.4. Cardiac Disease

00:38:43 4.2.5. Sepsis

00:39:34 4.2.6. Drug toxicity and overdose

00:42:01 4.2.7. Eclampsia

00:42:41 4.2.8. Intracranial haemorrhage

00:43:09 4.2.9. Anaphylaxis

00:46:03 4.2.10. Other causes

00:47:01 4.3. What are the physiological and anatomical changes in pregnancy that affect resuscitation?

00:48:45 4.3.1. Aortocaval compression

00:50:36 4.3.2. Respiratory changes

00:51:54 4.3.3. Intubation

00:52:33 4.3.2. Aspiration

00:53:51 4.3.5. Circulation

00:55:02 4.4. What is the optimal initial management of maternal collapse?

00:55:10 4.4.1. Resuscitation in maternal collapse

01:00:00 4.4.2 Relieving aorto-caval compression

01:03:58 4.4.3 Airway

01:07:11 4.4.4 Breathing

01:08:58 4.4.5 Circulation

01:15:25 4.4.6 Drugs

01:15:47 4.4.7 Other considerations

01:16:59 4.5 When, where and how should perimortem caesarean section (PMCS) be performed?

01:25:27 4.6 What does the ongoing management consist of?

01:26:47 4.6.1 Haemorrhage

01:29:31 4.6.2 Venous thromboembolism

01:30:36 4.6.3 Amniotic fluid embolism

01:34:28 4.6.4 Cardiac disease

01:35:44 4.6.5 Sepsis

01:39:48 4.6.6 Drug overdose and toxicity

01:40:27 4.6.6.1 Magnesium sulphate

01:41:23 4.6.6.2 Local anaesthetic agents

01:46:18 4.6.7 Eclampsia

01:46:58 4.6.8 Intracranial haemorrhage

01:47:54 4.6.9 Anaphylaxis

01:50:29 4.7 What are the outcomes for mother and baby?

01:57:28 4.8 Who should be on the team?

02:00:59 5 Clinical governance

02:01:03 5.1 Documentation

02:02:05 5.2 Incident reporting

02:03:57 5.3 Training

02:07:27 5.4 Debriefing

02:08:26 6 Recommendations for future research

02:09:01 7 Auditable topics

02:10:05 8 Useful links and support groups

02:12:04 Disclosures of interest

02:12:15 Funding

02:13:13 Appendix 1: Explanation of guidelines and evidence levels

02:14:35 Appendix 2: Causes of maternal collapse

02:17:04 Appendix 3: Physiological and physical changes in pregnancy

02:20:52 Appendix 4: Maternal collapse algorithm

02:21:23 Appendix 5: Recommended airway equipment

02:21:57 Appendix 6: Post collapse management

02:22:25 References

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.

An assisted vaginal birth is when a healthcare professional uses specially designed instruments to help you give birth to your baby. This information is for you if you wish to know more about assisted vaginal birth.

Perineal tears during childbirth - what you need to know during pregnancy by Royal College of Obstetricians and Gynaecologists

Care of a third- or fourth-degree tear that occurred during childbirth by Royal College of Obstetricians and Gynaecologists