Guidelines in Obstetrics and Gynaecology

In the modern era, in every specialty of medicine, there are guidelines issued by various medical bodies/colleges which practicing doctors have to follow. Obstetrics & Gynaecology, my field of expertise, is no exception. We have following bodies whose guidelines we follow:

• American College of Obstetricians & Gynecologists (ACOG)
• Royal College of Obstetricians & Gynecologists (RCOG)
• Society of Obstetricians & Gynecologists of Canada (SPGC)
• Royal Australian and New Zealand College of Obstetricians & Gynecologists (RANZCOG): incidentally the current vice president of this college is Indian: Prof. Ajay Rane
• National Institute for Health and Clinical Excellence (NICE)

Many examiners at various postgraduate examinations are fond of asking guidelines for management of a certain disease; the most commonly asked guidelines are those by RCOG. I think this is unfair and unnecessary for various reasons:

1. These guidelines are based on evidenced based studies in the country where these guidelines originate. Thus RCOG guidelines are not suitable and cannot be applied to Indian women who are ethnically different.
2. The guidelines given for a particular disease condition are very extensive and run into many pages: it is impossible for a student to learn and know them verbatim. My clinician friends from abroad have confessed to me that they do not remember every single point in detail.
3. There are so many different guidelines that students are confused about which ones they must know.

My take on clinical guidelines is as follows:

• Clinical guidelines are recommendations by colleges or associations on the appropriate treatment and care of people with specific diseases and conditions within the country. They are based on the best available evidence. While clinical guidelines help health professionals in their work, they do not replace their knowledge and skills.
• Guidelines are just that: Guidelines! One has to follow them in spirit and not to the letter. In a given exceptional case one should have the freedom to deviate from them in the interest of the patient.
• We do not have any worthwhile guidelines for Obstetrics & Gynaecology in India. They should be formulated by clinicians who are experts in their respective specialities; and not by doctors who are Professors/HOD in medical colleges or Office bearers of the Federation/College or their friends.
• They should be based on evidence based studies/ RCTs: this is where the main problem lies. We do not have enough evidence in Indian literature yet on which to base these guidelines.