Green-top Guidelines

Monochorionic Twin Pregnancy, Management – 2024 Partial Update (Green-top Guideline No. 51)

A partial update of this guideline was undertaken following the publication of NICE Guideline [NG137] Twin and triplet pregnancy addressing the use of cell free fetal DNA (cffDNA) in screening for major anomalies, as well as changes to the care and management of monochorionic twin pregnancies regarding selective growth restriction and screening twin anaemia polycythaemia sequence (TAPS). There is also an additional section on timing of birth for complicated and uncomplicated monochorionic twin pregnancies.

Published: 18/02/2025

Identification and management of maternal sepsis during and following pregnancy (Green-top Guideline No. 64) 

The scope of this guideline covers the recognition and management of sepsis in the antenatal, intrapartum and postpartum periods, including post-abortion sepsis. The scope includes bacterial infections arising in the genital tract or elsewhere and influenza and their management in secondary care. Sepsis arising due to primary viral (other than influenza and HSV) or parasitic infection is outside the scope of this guideline.

Published: 18/12/2024

Care of late intrauterine fetal death and stillbirth (Green-top Guideline No. 55)

The purpose of this guideline is to identify evidence-based options for parents and their families who have a late intrauterine fetal death (IUFD) after 24+0 completed weeks of pregnancy of a singleton fetus and to incorporate information on general care before, during and after birth, and care in future pregnancies.

Published: 28/10/2024

Outpatient Hysteroscopy (Green-top Guideline No. 59)

The aim of this guideline is to provide clinicians with up to date, evidence-based information regarding outpatient hysteroscopy, with particular reference to minimising pain and optimising the experience of the woman or person.

Published: 19/08/2024

Small-for-Gestational-Age Fetus and a Growth Restricted Fetus, Investigation and Care (Green-top Guideline No. 31)

This guideline provides advice regarding the investigation and care of the small-for-gestational age fetus and fetal growth restricted fetus. It reviews the risk factors for these conditions and provides recommendations regarding surveillance, diagnosis and management, including recommendations for fetal monitoring and birth. 

Published 14/05/2024

The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69)

The guideline provides updated evidence-based or best clinical practice information regarding the diagnosis and subsequent management of nausea and vomiting in pregnancy (NVP) and hyperemesis gravidarum (HG) across community, ambulatory day care and inpatient settings.

Published 05/02/2024

Recurrent Miscarriage (Green-top Guideline No. 17)

The guideline provides comprehensive information on risk factors, recommended investigations and treatments for recurrent first trimester and one or more second trimester miscarriages.

Published 19 June 2023

Intrahepatic cholestasis of pregnancy (Green-top Guideline No. 43)

This guideline summarises the evidence regarding the diagnosis, and the maternal and fetal risks of intrahepatic cholestasis of pregnancy (ICP), previously called obstetric cholestasis.

Published 09/08/2022

Cervical cerclage (Green-top Guideline No. 75)

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.

Published 24/02/2022

Antenatal corticosteroids to reduce neonatal morbidity and mortality (Green-top Guideline No. 74)

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.

Published 17/02/2022

Amniocentesis and Chorionic Villus Sampling (Green-top Guideline No. 8)

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).

Published 25/10/2021

Gestational Trophoblastic Disease (Green-top Guideline No. 38)

This guideline describes the presentation, management, treatment and follow-up of gestational trophoblastic disease (GTD) and gestational trophoblastic neoplasia (GTN).

Published 30/09/2020

Assisted Vaginal Birth (Green-top Guideline No. 26)

This guideline provides evidence-based information on the use of forceps and vacuum extractor for both rotational and non-rotational operative vaginal deliveries.

Published 29/04/2020

Maternal Collapse in Pregnancy and the Puerperium (Green-top Guideline No. 56)

This guideline covers the different causes of maternal collapse, the identification of women at increased risk and the management of maternal collapse. 

Published 17/12/2019

Care after non-invasive pre-natal testing (NIPT)

This is the proposed scope for the new RCOG Green-top Guideline on Non-Invasive Prenatal Testing.

Published 31/0/2019

Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation (Green-top Guideline No. 73)

This guideline covers recommendations for 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.

Published 18/06/2019

Care of Women with Obesity in Pregnancy (Green-top Guideline No. 72)

This guideline covers interventions prior to conception, and during and after pregnancy when caring for women with obesity.

Published 22/11/2018

Vasa Praevia: Diagnosis and Management (Green-top Guideline 27b)

This guideline describes the diagnostic modalities and reviews the evidence-based approach to the clinical management of pregnancies complicated by vasa praevia.

Published 27/09/2018

Placenta Praevia and Placenta Accreta: Diagnosis and Management (Green-top Guideline No. 27a)

This guideline describes the diagnostic modalities and reviews the evidence-based approach to the clinical management of pregnancies complicated by placenta praevia and placenta accreta.

Published 27/09/2018

Group B Streptococcal Disease, Early-onset (Green-top Guideline No. 36)

This guideline provides guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal group B streptococcal (EOGBS) disease.

Published 13/09/2017

Management of Inherited Bleeding Disorders in Pregnancy (Green-top Guideline No. 71)

This guideline is intended for both specialist haematologists and obstetricians who have experience in managing pregnant patients with bleeding disorders. In addition, it may be a useful reference text for obstetric anaesthetists and neonatologists.

Published 27/04/2017

External Cephalic Version and Reducing the Incidence of Term Breech Presentation (Green-top Guideline No. 20a)

This guideline summarises the evidence regarding the routine use of external cephalic version (ECV) for breech presentation.

Published 16/03/2017

Management of Breech Presentation (Green-top Guideline No. 20b)

This guideline provides up-to-date information on methods of delivery for women with breech presentation.

Published 16/03/2017

Postpartum Haemorrhage, Prevention and Management (Green-top Guideline No. 52)

This guideline provides information about the prevention and management of postpartum haemorrhage (PPH), primarily for clinicians working in obstetric-led units in the UK; recommendations may be less appropriate for other settings where facilities, resources and routine practices differ.

Published 16/12/2016

Management of Bladder Pain Syndrome (Green-top Guideline No. 70)

This guideline provides evidence-based information for primary and secondary care clinicians on the symptoms and treatment options for bladder pain syndrome (BPS) in women.

Published 09/12/2016

Premenstrual Syndrome, Management (Green-top Guideline No. 48)

This guideline reviews the diagnosis, classification and management of premenstrual syndrome. In addition, the evidence for pharmacological and nonpharmacological treatments is examined.

Published 01/12/2016

Monochorionic Twin Pregnancy, Management (Green-top Guideline No. 51)

This guideline provides clinicians with up-to-date evidence-based information regarding the management of monochorionic twin pregnancy.

Published 16/11/2016

Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21)

This guideline provides evidence-based guidance on the diagnosis and management of ectopic pregnancies.

Published 04/11/2016

Ovarian Cysts in Postmenopausal Women (Green-top Guideline No. 34)

This guideline provides information on the investigation and management of postmenopausal women with known ovarian cysts.

Published 19/07/2016

Birth after Previous Caesarean Birth (Green-top Guideline No. 45)

This guideline provides evidence-based information to inform the care of women undergoing either planned vaginal birth after previous caesarean section (VBAC) or elective repeat caesarean section (ERCS).

Published 01/10/2015

Post-Hysterectomy Vaginal Vault Prolapse (Green-top Guideline No. 46)

This guideline aims to assist generalist and subspecialist gynaecologists in the management of posthysterectomy vaginal vault prolapse (PHVP). The management of urinary incontinence is not covered in this guideline; however, the role of concomitant continence procedures at the time of surgery for vault prolapse is addressed.

Published 24/07/2015

Female Genital Mutilation and its Management (Green-top Guideline No. 53)

This guideline reviews the evidence on female genital mutilation (FGM) and provides guidance for clinicians involved in the care of women who have undergone FGM.

Published 10/07/2015

Third- and Fourth-degree Perineal Tears, Management (Green-top Guideline No. 29)

This guideline provides evidence-based guidance on the diagnosis, management and treatment of third- and fourth-degree perineal tears (obstetric anal sphincter injuries, referred to as OASIS). 

Published 12/06/2015

Blood Transfusions in Obstetrics (Green-top Guideline No. 47)

This guideline offers guidance about the appropriate use of blood products that neither compromises the affected woman nor exposes her to unnecessary risk. Strategies to maximise the haemoglobin (Hb) level at delivery as well as to minimise blood loss are also discussed.

Published 29/05/2015

Thrombosis and Embolism during Pregnancy and the Puerperium: Acute Management (Green-top Guideline No. 37b)

This guideline provides advice on the immediate investigation and management of women in whom venous thromboembolism (VTE) is suspected during pregnancy and the puerperium.

Published 13/04/2015

Thrombosis and Embolism during Pregnancy and the Puerperium, Reducing the Risk (Green-top Guideline No. 37a)

This guideline provides advice on the prevention of venous thromboembolism (VTE) during pregnancy and birth and following delivery.

Published 13/04/2015

Chickenpox in Pregnancy (Green-top Guideline No. 13)

This guideline assesses the evidence regarding the maternal and fetal risks of varicella zoster virus (VZV) infection in pregnancy and whether these complications can be prevented or modified by the administration of varicella zoster immune globulin (VZIG) or by treatment with aciclovir.

Published 21/01/2015

Polycystic Ovary Syndrome, Long-term Consequences (Green-top Guideline No. 33)

This guideline has been archived. This topic is covered by the International Evidence-based Guideline for the assessment and management of polycystic ovary syndrome.

Archived 13/12/2024 

Umbilical Cord Prolapse (Green-top Guideline No. 50)

This guideline provides evidence-based advice on the prevention, diagnosis and management of umbilical cord prolapse.

Published 05/11/2014

Red Cell Antibodies during Pregnancy, The Management of Women with (Green-top Guideline No. 65)

This guideline aims to assist clinicians with the initial assessment and appropriate management of pregnant women with red blood cell antibodies.

Published 28/05/2014

Thalassaemia in Pregnancy, Management of Beta (Green-top 66)

This guideline provides evidence-based guidance on the management of women with beta (β) thalassaemia major and intermedia in pregnancy.

Published 27/03/2014

Small-for-Gestational-Age Fetus, Investigation and Management (Green-top Guideline No. 31)

This guideline reviews the risk factors for a small-for-gestational-age (SGA) fetus and provides recommendations regarding screening, diagnosis and management, including fetal monitoring and delivery.

Published 22/03/2013

Chronic Pelvic Pain, Initial Management (Green-top Guideline No. 41)

This guideline provides an evidence-based summary for the generalist to facilitate appropriate investigation and management of women presenting for the first time with chronic pelvic pain.

Published 23/05/2012

Sepsis in Pregnancy, Bacterial (Green-top Guideline No. 64a)

This guideline has been archived.

Please see the replacement guideline, Identification and management of maternal sepsis during and following pregnancy Green-top Guideline No. 64).

Archived 19/12/2024

Sepsis following Pregnancy, Bacterial (Green-top Guideline No. 64b)

This guideline has been archived.

Please see the replacement guideline, Identification and management of maternal sepsis during and following pregnancy Green-top Guideline No. 64).

Archived 19/12/2024

Shoulder Dystocia (Green-top Guideline No. 42)

This guideline reviews the evidence regarding the possible prediction, prevention and management of shoulder dystocia.

Published 28/03/2012

Antepartum Haemorrhage (Green-top Guideline No. 63)

This guideline provides advice for clinicians working in obstetric units on how to deal with antepartum haemorrhage.

Published 05/12/2011

Ovarian Masses in Premenopausal Women, Management of Suspected (Green-top Guideline No. 62)

This guideline aims to assist clinicians with the initial assessment and appropriate management of suspected ovarian masses in premenopausal women.

Published 02/12/2011

Sickle Cell Disease in Pregnancy, Management of (Green-top Guideline No. 61)

This guideline describes the management of pregnant women with sickle cell disease, including preconceptual screening and antenatal, intrapartum and postnatal management.

Published 26/08/2011

Venous Thromboembolism and Hormone Replacement Therapy (Green-top Guideline No. 19)

This guideline has been archived. Please see the guideline produced by the Faculty of Sexual and Reproductive Healthcare (FSRH).

Published 31/05/2011

Cervical Cerclage (Green-top Guideline No. 60)

This guideline has been archived. Please see Green-top Guideline No. 75 Cervical cerclage and the NICE guideline [NG25] Preterm labour and birth.

Published 19/05/2011

Recurrent Miscarriage, Investigation and Treatment of Couples (Green-top Guideline No. 17)

This guideline provides guidance on the investigation and treatment of couples with three or more first-trimester miscarriages, or one or more second-trimester miscarriages.

Published 19/05/2011

Obstetric Cholestasis (Green-top Guideline No. 43)

This guideline summarises the evidence for the fetal risks associated with obstetric cholestasis and provides guidance on the different management choices and the options available for its treatment.

Published 19/05/2011

Rhesus D Prophylaxis, The Use of Anti-D Immunoglobulin for (Green-top Guideline No. 22)

This guideline has been archived. Please see the British Committee for Standards in Haematology (BCSH) guideline on anti-D administration in pregnancy.

Published 27/04/2011

Hysteroscopy, Best Practice in Outpatient (Green-top Guideline No. 59)

This guideline provides clinicians with evidence-based information regarding outpatient hysteroscopy, with a focus on minimising pain and optimising the woman’s experience.

Published 27/04/2011

Reduced Fetal Movements (Green-top Guideline No. 57)

This guideline reviews the risk factors for reduced fetal movements in pregnancy and makes management recommendations

Published 25/02/2011

Vulval Skin Disorders, Management (Green-top Guideline No. 58)

This guideline has been archived. Please see the British Association for Sexual Health and HIV (BASHH) guideline on the management of vulval conditions.

Published 22/02/2011

Preterm Labour, Tocolytic Drugs (Green-top Guideline No. 1B)

This guideline has been archived. Please see the NICE guideline [NG25] Preterm labour and birth.

Published 22/02/2011

Late Intrauterine Fetal Death and Stillbirth (Green-top Guideline No. 55)

This guideline identifies evidence-based options for women who have a late intrauterine fetal death of a singleton fetus.

Published 10/11/2010

Antenatal Corticosteroids to Reduce Neonatal Morbidity (Green-top Guideline No. 7)

This guideline has been archived. Please see the NICE guideline [NG25] Preterm labour and birth.

Published 31/10/2010

Preterm Prelabour Rupture of Membranes (Green-top Guideline No. 44)

This guideline has been archived. Please see GTG No. 73 Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes, and the NICE guideline [NG25] Preterm labour and birth.

Published 01/10/2010

Venous Thromboembolism and Hormonal Contraception (Green-top Guideline No. 40)

This guideline has been archived. Please see the Faculty of Sexual and Reproductive Healthcare (FSRH) statement on venous thromboembolism and hormonal contraception.

Published 27/09/2010

Malaria in Pregnancy, Diagnosis and Treatment (Green-top Guideline No. 54B)

This guideline provides clinicians with evidence-based information on the diagnosis and treatment of malaria in pregnancy in situations likely to be encountered in UK medical practice.

Published 28/04/2010

Malaria in Pregnancy, Prevention (Green-top Guideline No. 54A)

This guideline provides clinicians with evidence-based information about the prevention of malaria in pregnancy in situations likely to be encountered in UK clinical practice (i.e. in UK residents visting malaria endemic areas).

Published 28/04/2010