How to Study Green-Top Guidelines?

This blog post is very basic advice regarding your preparation for the MRCOG exam. I am going to share a few tips to cover the GTGs which might be helpful in retaining the enormous information. I have added ALL GTGs Algorithms at the end of the post.

As we all know that green top guidelines are one of the backbones of the MRCOG exam. They are regarded as the ‘Bible’ for any topic. You have to know these words by word and by heart. If one goes and sits for the exam without GTGs, it's like he/she is on a suicide mission. I think I can not emphasise more on its importance.

The most important tip to understand and memorise GTGs is “to revise it as many times as you can or at least 3 times”

Steps to cover GTGs

• First of all, visit the RCOG website and search for all the guidelines. I have compiled all the green top guidelines in one of the blog posts. You will get one-click downloadable links to all GTGs. 
• To access the post: Click Here
• Make sure to have the latest version of the guideline
• Decide whether you want to use soft copy or a printed form

GTG # 26 Assisted Vaginal Birth

This post is the summary of GTG #26 Assisted Vaginal Birth which was released in April 2020. This guideline has been update in detail with few recommendations which are different from previous version.

In this post, important points from the guideline (which could be tested in exam) are extracted. It is strongly recommended to read the original document to develop deep understanding of this guideline.

I hope this summary is helpful. 
Your feedback and suggestions to improve future posts are welcome. 

Thanks 

To download the guideline : Click Here

ASSISTED VAGINAL BIRTH

Introduction

• Incidence of Assisted Vaginal Birth (AVB) in UK → 10-15%
• 1:3 Nulliparous deliver by vacuum or forceps

Preparation for assisted vaginal birth (AVB)

Avoiding AVB

Factors which can reduce the need

• Continuous support during labour specially when carer is not a staff member 
• If not using epidural → adopt upright or lateral position in 2nd stage of labour
• With low-dose epidural→ 6% absolute ↑ in chance of spontaneous vaginal birth if lying down vs upright in 2nd stage 
• Delayed pushing for 1-2 hrs recommended in nulliparous with epidural (↓ rotational/ mid pelvic AVB)

Factors which can increase the need

• Epidural analgesia although less likely with newer techniques

No effect

• Epidural either in latent phase or active phase
• Discontinuing epidural analgesia during pushing → No ↓ incidence of AVB, but ↑ woman's pain  (22% vs 6%)

Insufficient evidence to recommend for reducing incidence of AVB

• Any particular regional analgesia technique
• Routine oxytocin augmentation for women with epidural
• Routine prophylactic manual rotation of fetal malposition in 2nd stage of labour
• Different studies:

• Manual rotation→ 90% success rate with ↓ in operative birth. Also ↓ duration of 2nd stage 
• If corrected fetal malposition by manual rotation in early 2nd stage→ no difference in rate of AVB
• Larger RCTs are needed

Defining AVB

• Use standard classification system Table 1 and perform systematic abdominal & vaginal examination