About RCOG guidelines
Guidelines make recommendations about specific aspects of conditions, investigations, procedures and treatments that relate to the medical health of women. See all of our clinical guidelines.
Clinical guidelines are based on the best available evidence. They help to ensure that women receive care which has evidence or expert opinion to support it rather than being based on ‘individual opinion’ (anecdotal). Guidelines also help to ensure that each woman has an equal opportunity to obtain the best care.
Guidelines are recommendations. They are not meant to dictate rigidly, but to support healthcare professionals in their work. In deciding what treatment or care to offer, the doctor, nurse or midwife will always take account of an individual’s need, local conditions and resources.
How is an RCOG guideline developed?
In the first instance, a team of people responsible for producing the guideline identifies the reason or reasons why a particular guideline is needed. At the RCOG, this team is usually the Guidelines Committee. This committee works in collaboration with the RCOG Women’s Network and relevant professional societies to identify a relevant guideline.
A guideline may be needed for a number of reasons. It could be that there have been rapid developments in a particular area of practice, or that significant new evidence has become available on a particular condition. Alternatively, it may be that a guideline on a specific procedure would encourage consistency of approach and care.
Once the need for a guideline has been identified, the questions the guideline needs to answer are considered. These questions provide the purpose and scope of the guideline. The authors responsible for developing the guideline, who will include an appropriately qualified expert or group of experts, write an initial scope. This scope is then approved by the RCOG Guidelines Committee.
A systematic search of the published evidence is carried out using large, international databases of scientific research and healthcare reports. This covers the areas within the scope of the guideline. The methods used to search for the evidence are also described in the guideline.
At the next stage, the guideline authors assess all the evidence gathered. This involves looking at each study and identifying how it was carried out. This is important because the way in which a scientific study is carried out has a bearing on how reliable and valid and significant its findings are. To illustrate this, if a study reports that a healthcare treatment is effective, then it is important to see how the study was carried out, that is, how the treatment was assessed. One of the best ways of assessing a treatment is to compare it with an alternative treatment or with no treatment at all. This type of investigation is known as a randomised controlled trial (RCT).
What is a randomised controlled trial (RCT)?
Randomised controlled trials are designed to test the effectiveness and safety of healthcare interventions (that is, treatments or procedures) as fairly and objectively as possible. RCTs ensure that, as far as possible, the results of a test or trial are not due to bias.
If results are available from a number of trials for a particular intervention, then this is likely to provide evidence that is more reliable than evidence from a single trial.
What are systematic reviews?
Systematic reviews use standardised, pre-defined methods to:
- Find all relevant studies on a specific topic
- Address the quality of these studies
- Ascertain whether these studies should be included or excluded from the review
- Summarise the results of those studies of adequate quality
The best evidence comes from good systematic reviews. Some systematic reviews include a meta-analysis which is a statistical summary of the results of the included studies.
In addition to looking at the evidence for healthcare treatments, authors may also assess evidence on particular interventions and procedures for diagnosing conditions. Different types of studies are used in these instances, which are not randomised controlled trials. These studies have specific factors which require careful assessment to ensure that they are not biased. It is also possible to combine these in systematic reviews to help inform practice.
How is the level of evidence graded?
The guideline authors grade the evidence in a hierarchy from level 1 to level 4, depending on the methods used to gather it. These are described on the final page of each of the guidelines (see ‘Classification of evidence level’ on each guideline).
The guideline authors draw up a number of recommendations, based on the evidence they have gathered, and provide a summary of the evidence that supports each recommendation.
Recommendations are graded according to the strength of the evidence that supports them. The grades of recommendations are Grade A, B, C and ‘good practice point’. These are described on the final page of each of the guidelines (see Grades of Recommendations on each guideline).
A summary of the evidence that supports each recommendation is also provided. The guideline includes a list of references to the evidence for recommendations.
The authors may also identify areas of uncertainty. These are areas where further research is needed. The guideline may suggest specific standards (known as audit standards) which will enable a service to measure its performance.
The draft guideline document then goes through a process of consultation (see section on ‘Peer review’).
After this, the guideline is approved by the Guidelines and Audit Committee and the RCOG Standards Board Committee (see section on ‘Final approval’).
RCOG parallel information for the public
The RCOG aims to support women in understanding what they can expect of their health care. It produces parallel information for the public which is designed to be:
- Used and adapted by each unit within the UK and Ireland
- Readily available
- Easy to understand
What does information for the public include?
Information for the public usually covers, in plain language, the recommendations made in the equivalent guideline. It also includes:
- A series of questions and answers women are most likely to want to know. Examples of these questions might include:
- What is this intervention/condition?
- What could it mean for me?
- What could it mean for my baby?
- What treatment is available?
- What are the risks and benefits of interventions/treatments?
- A link to the equivalent guideline or statement
- The date of publication and review date
How is information for the public produced?
Information, based on the guidelines, is developed by the RCOG’s Patient Information Committee and consists of consumer representatives and clinicians.
The Patient Information Committee identifies a guideline from which to produce parallel information and prepares a first draft. This is discussed and revised by the Patient Information Committee.
Draft guidelines as well as parallel information for the public go through a number of revisions before publication. This process is known as peer review. It helps to ensure that the RCOG draft:
- Guideline is evidence-based and practical
- Information for the public accurately reflects the guideline in an accessible way
The draft guideline document is circulated to expert health professionals (obstetricians, gynaecologists, midwives).
RCOG parallel information for the public
The draft information for the public is circulated to:
- Relevant clinicians (including RCOG members and fellows)
- The RCOG Women’s Network
- Consumer representatives
- Relevant voluntary sector organisations
- Identified outpatient clinics for women who are attending to comment on.
As part of the peer review process, draft documents are also posted on the public section of the RCOG website (under Consultation documents). This means that everyone who wishes to comment has an opportunity to do so.
Respective drafts go through a number of revisions, based on reviewers comments. The Patient Information Committee considers peer reviewers’ comments and then agree all changes necessary.
Before publication, the final version of the guideline and patient information must be approved by the Clinical Quality Board.
Informing healthcare professionals and the public
Guidelines and parallel patient information are publicly available on the RCOG website.
Keeping information up-to-date
Guidelines are reviewed three years after publication. They are either:
- updated – if new evidence has emerged that needs to be included, or
- withdrawn – if the guideline is no longer relevant
Occasionally a guideline may need to be reviewed within three years of publication. This is usually because new evidence emerges with important implications for practice.
Parallel information for the public is also reviewed in line with the guideline. As a minimum, the information is updated whenever the equivalent guideline is revised.
Is there anything else I should know?
- RCOG information for the public is not meant to replace personal advice from a doctor, midwife or nurse about your own situation.
- Information for the public may not cover every aspect of care for a particular condition. Links to other sources of evidence-based information and organisations that offer appropriate support are provided below.
This information is based on the appendix to all RCOG Green-top Guidelines and on Clinical Governance Advice No. 1: Guidance for the Development of RCOG Green-top Guidelines.
These websites provide more information about evidence-based medicine and clinical trials.