Knowledge Area 8 | Management of Delivery
(Aligned with RCOG Core Curriculum 2019)
This knowledge area focuses on the safe conduct of vaginal and operative delivery, including Caesarean section, perineal trauma, and intrapartum complications.
What the RCOG Curriculum Expects
The curriculum expects competence in:
- Decision-making for mode of delivery
- Operative vaginal birth
- Caesarean section
- Management of perineal trauma
- Recognition and management of complications
- Counselling for future pregnancies
Operative Vaginal Delivery (OVD)
- You must know: Indications; Prerequisites; Contraindications; Choice between forceps and vacuum; Documentation requirements
- Understand: Fetal head position assessment; Station; Rotational deliveries; Abandonment criteria
- Clinical assessment before instrumental birth is frequently tested.
Caesarean Section (CS)
- You must know: Classification of urgency; Indications; Consent and counselling; VBAC counselling; Risks in future pregnancies
- Special situations: Placenta praevia; CS at full dilatation; Perimortem CS; Complications (haemorrhage, bladder injury, VTE, infection)
- The exam often tests: When to convert to CS; Decision-to-delivery interval; Counselling for repeat CS
Perineal Trauma
- You must know: Classification of tears; Recognition of OASI; Repair principles; Post-repair care; Antibiotics; Physiotherapy referral; Future delivery counselling
- Pelvic floor consequences are increasingly emphasised.
Malposition and Malpresentation at Delivery
- Understand: Occipito-posterior; Deep transverse arrest; Face and brow presentations
- Know management in second stage.
Cord Management
- Know: Delayed cord clamping; Indications for early clamping; Placental transfusion principles; Cord blood banking basics
Immediate Complications at Delivery
- Be prepared for: Shoulder dystocia; Cord prolapse; Uterine rupture; Severe fetal compromise
- Understand immediate manoeuvres and escalation.
Maternal Morbidity and Mortality
- You should be familiar with themes from recent MBRRACE-UK reports: Sepsis; Thrombosis; Cardiac disease; Haemorrhage
- The exam may test awareness of preventable factors.
How This Knowledge Area Is Tested
Common themes include:
- Instrument selection
- Failure criteria
- Counselling before OVD
- When to proceed to CS
- OASI repair principles
- Managing complications at full dilatation
Decision-making and safety are heavily weighted.
Final Words
Before any delivery decision, ask:
- Is vaginal birth safe?
- Are prerequisites met?
- Is senior help required?
- Have I counselled appropriately?
- What are implications for future pregnancies?
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Operative Vaginal Delivery |
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GTG |
#26 Assisted Vaginal Birth 2020 |
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CA |
#11 Operative Vaginal Delivery 2010 |
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TOG |
Clinical assessment for instrumental birth |
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Caesarean Section |
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GTG |
#45 Birth after previous Caesarean Birth |
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NICE |
NG192 Caesarean Birth 2025 |
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CA |
#7 Caesarean Section #12 C/S for Placenta Previa 2010 #14 Planned Caesarean Birth 2022 |
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GP |
#11 Classification of Urgency of C/S |
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TOG |
Gynaecological morbidity associated with CS niche 2020 Acute colonic pseudo-obstruction after CS 2019 Perimortem C/S- why, when and how 2018 Complications of C/S 2016 C/S at full dilatation 2014 Counselling women about risks of C/S delivery on future pregnancies 2014 |
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Perineal Tear |
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GTG |
#29 Management of Third-and-Fourth-degree Perineal Tears |
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CA |
#9 Repair of Third-and-Fourth- degree Perineal Tears following childbirth |
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TOG |
Obstetrics pelvic floor and anal sphincter injuries 2012 |
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Obstetrical Emergencies |
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GTG |
#42 Shoulder Dystocia #50 Umbilical Cord Prolapse #56 Maternal Collapse in Pregnancy and Puerperium |
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Maternal Mortality |
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MBBRACE |
The term stands for Mothers Babies: Reducing Risk through Audits and Confidential Enquiries across UK You need to collect and go though at least last 2 reports in order to make the comparison and these numbers should be on fingertips |
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TOG |
Autopsy in the event of maternal death —a UK Perspective 2019 |