The obstetrics and gynaecology drug approval and enforcement feeds both returned nothing today, which is normal — drug regulators rarely issue anything obstetricians act on directly, and ACOG, RCOG, FIGO and FOGSI documents published as web pages do not reach this sweep at all.
The substantive item is ACOG's new clinical practice guideline on obstetric cerclage. It is a full guideline rather than a committee opinion: developed against an a priori protocol by three maternal-fetal medicine subspecialists, with a comprehensive librarian-led literature search across Cochrane, CENTRAL, Embase, PubMed and MEDLINE, standardised inclusion criteria, formal quality assessment, and a modified GRADE evidence-to-decision framework. Recommendations are classified by strength and by evidence quality.
It covers indications, surgical approach, management and alternatives, across the three populations that come up in clinic: cervical insufficiency, prior obstetric history, and cervical shortening on ultrasound.
The methodology matters as much as the content. Cerclage practice varies enormously between units and between individual obstetricians, and much of that variation rests on training lineage rather than on evidence. A document that separates strong recommendations from conditional ones, and states the evidence quality behind each, gives a unit something to audit against.
The practical step is to compare your own indications list against the guideline's, particularly for the ultrasound-indicated cerclage where practice is least consistent, and to check what it says about alternatives — vaginal progesterone and pessary — before offering a procedure.
- Compare your unit's cerclage indications against the new ACOG guideline, particularly for ultrasound-indicated cerclage
- Check the recommendations on alternatives before offering surgery — progesterone and pessary are covered
- Note which recommendations are strong and which conditional; the guideline classifies both strength and evidence quality
- Use it to audit practice variation between clinicians within your own unit
- Remember the coverage gap: ACOG, RCOG, FIGO and FOGSI web publications do not reach this feed
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free