Essential Reading for Your O&G ST1 Interview

Walking into your O&G ST1 interview without a solid grasp of the major national reports and landmark evidence is a bit like turning up to a CTG interpretation station without knowing what a deceleration looks like. The interviewers are not expecting you to recite page numbers, but they do want to see that you understand the landscape of the specialty you are applying to join. Demonstrating awareness of key reports, recent guideline updates, and practice-changing trials shows that you are engaged, safety-conscious, and ready to hit the ground running as a trainee.

This post pulls together the essential reading that crops up repeatedly in interview scenarios. We have summarised the main takeaways from each so you can build a working knowledge quickly, but we strongly encourage you to read the executive summaries of the original documents where possible. Interviewers can tell the difference between someone who has genuinely engaged with the material and someone who memorised a bullet-point list the night before.

MBRRACE-UK: Saving Lives, Improving Mothers' Care

If there is one report you absolutely must know for your interview, it is MBRRACE-UK. The Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK programme is the national confidential enquiry into maternal deaths and morbidity. It is published annually and examines every maternal death that occurs during pregnancy or up to one year after the end of pregnancy in the UK and Ireland.

The most recent full report was published in September 2025 and covers deaths from 2021 to 2023. Note that the year in the title is when the report was published, not the years it covers. In this triennium, 257 women died during or up to six weeks after pregnancy among over two million women giving birth in the UK, representing a maternal death rate of 12.82 per 100,000 maternities.

Key findings from the 2025 report (2021--23 data):

• Thrombosis and thromboembolism was the leading cause of maternal death during or up to six weeks after pregnancy. Cardiac disease and COVID-19 were joint second.

• Suicide remained the leading cause of late maternal death (six weeks to one year postpartum). Deaths from psychiatric causes accounted for 34% of late maternal deaths in this period.

• Stark health inequalities persist: Black women were 2.3 times more likely to die than White women (a rate of 28.21 vs 12.44 per 100,000). Asian women had 1.3 times the risk. Women in the most deprived areas had 1.9 times the mortality rate of those in the least deprived (19.27 vs 10.25 per 100,000). Women aged 35 and over were 1.6 times more likely to die than those aged 25--29.

• Of the 643 women whose care was reviewed in the confidential enquiries, 91% (583 women) faced multiple interrelated challenges including physical health problems, mental health issues, deprivation, domestic abuse, and substance use.

• A major recurring theme was the importance of pre-pregnancy counselling and getting women with co-morbidities "ready for pregnancy."

• Key new recommendations included: establishing urgent referral pathways for high-risk women in early pregnancy, improving discharge summaries with a clear summary box for postnatal management, standardised assessment of social risk factors at booking, and better information sharing for safeguarding concerns.

Interview tip: Be prepared to discuss what MBRRACE is, its key findings on leading causes of death, and health inequalities. You can show off by mentioning how you would help address these problems, for example by ensuring thorough VTE risk assessment or recognising red flags for maternal mental health deterioration.

Each Baby Counts (EBC)

Each Baby Counts was a landmark RCOG quality improvement programme that ran from 2014 to 2020. It collected data on every term baby in the UK who was stillborn, died within the first week of life, or sustained a severe brain injury during labour. The programme aimed to halve these adverse outcomes by 2020.

Key findings:

• In approximately 70--80% of cases reviewed, different care might have made a difference to the outcome.

• The most common contributory factors were errors in CTG interpretation, failure to escalate concerns, loss of situational awareness, and human factors issues.

• The programme highlighted the critical importance of multidisciplinary team working, structured approaches to fetal monitoring, and fostering a culture where junior staff feel empowered to escalate.

• Parent involvement in reviews of care improved over the programme's lifetime, with a 20% increase from 2017 to 2018 in trusts inviting parents to contribute.

The EBC programme has now concluded. However, the programme's successor, Each Baby Counts Learn & Support, continues as a joint RCOG and RCM initiative focused on improving clinical escalation in maternity units.

The Ockenden Review, Kirkup Report, and National Maternity Safety

Several high-profile independent investigations have shaped the current maternity safety landscape. You should know the key themes from these, as they frequently underpin interview questions on patient safety, governance, and professional culture.

The Ockenden Report (2022) investigated maternity care at Shrewsbury and Telford Hospital NHS Trust and examined around 1,592 family cases. It found that nearly 300 babies and multiple mothers died or were severely harmed due to unsafe care, poor communication, and a culture that at times prioritised "normal birth" ideology over safety. The report made over 60 immediate and essential actions covering workforce, training, escalation policies, and minimum safe staffing levels.

The Kirkup Report -- "Reading the Signals" (2022) investigated maternity and neonatal services at East Kent Hospitals. It found that if nationally recognised standards had been followed, outcomes could have been different in 97 of 202 cases reviewed. Rather than making specific policy recommendations, Dr Kirkup identified four pillars for reform: valid outcome measures, enhanced listening to families, common purpose within teams, and honest organisational responses to difficulties.

In 2025, the UK Government launched a national independent investigation into NHS maternity and neonatal services, led by Baroness Valerie Amos, examining care across 14 trusts. This reflects ongoing concern that the failings identified in individual trust reviews are not isolated incidents but represent systemic issues. A CQC national review of maternity services (2022--2024) found that poor care had become normalised, with no services inspected being rated as "outstanding" for safety.

Common themes across these reports: poor multidisciplinary teamworking, inadequate staffing, failure to listen to women and families, poor escalation culture, inadequate investigation of incidents, and persistent health inequalities.

Saving Babies' Lives Care Bundle (Version 3)

The Saving Babies' Lives Care Bundle (SBLCB) is NHS England's evidence-based framework for reducing perinatal mortality. Version 3 was published in June 2023 (updated to v3.2 in April 2025) and all maternity providers in England are expected to implement it. The care bundle supports the national ambition to halve stillbirths and neonatal deaths.

The six elements of SBLCBv3 are:

• Element 1 -- Reducing smoking in pregnancy: CO testing at booking, opt-out referral to in-house tobacco dependence advisers, and ongoing support throughout pregnancy.

• Element 2 -- Fetal growth surveillance: Risk assessment and surveillance for fetal growth restriction (FGR), including mid-trimester uterine artery Doppler screening for early-onset FGR and placental dysfunction.

• Element 3 -- Reduced fetal movement (RFM): Raising awareness among pregnant women about the importance of monitoring fetal movements and ensuring timely hospital attendance and assessment.

• Element 4 -- Effective fetal monitoring during labour: Competency in CTG interpretation, use of structured assessment tools, and appropriate escalation.

• Element 5 -- Preterm birth: Prediction, prevention, and perinatal optimisation, including the use of cervical length screening and progesterone where indicated.

• Element 6 (new in v3) -- Pre-existing diabetes in pregnancy: Management pathways for women with Type 1 and Type 2 diabetes, who face four to five times the risk of perinatal loss. This element focuses on multidisciplinary team pathways and improved glucose management.

Recent RCOG Green-top Guideline Updates

Green-top Guidelines (GTGs) are the RCOG's gold-standard evidence-based clinical guidelines. Knowing the most recent updates demonstrates that you are keeping up with evolving best practice. Here are the most important recent publications:

GTG No. 64 -- Identification and Management of Maternal Sepsis (December 2024): This is a major update, combining the previously separate guidelines on sepsis in and following pregnancy. Key recommendations include always considering sepsis in any pregnant or postpartum woman whose condition rapidly deteriorates, urgent escalation from community to hospital when sepsis is suspected, using obstetric early warning systems with multidisciplinary input, and measuring serum lactate urgently in high-risk cases. The guideline reflects the significant reduction in sepsis deaths since the previous edition, likely due to influenza vaccination, mandatory staff education, and implementation of sepsis protocols.

GTG No. 55 -- Care of Late Intrauterine Fetal Death and Stillbirth (October 2024): Updated guidance on the sensitive and evidence-based management of stillbirth, including investigation, delivery options, and bereavement care.

GTG No. 69 -- Nausea, Vomiting in Pregnancy and Hyperemesis Gravidarum (February 2024): Updated from the original 2016 guideline, this covers diagnosis, management pathways, and pharmacological treatment options for what can be a severely debilitating condition affecting up to 3 in 100 pregnant women. Updates include the use of Xonvea as the first-line drug.

GTG No. 51 -- Management of Monochorionic Twin Pregnancy (February 2025, partial update): New recommendations include using fetal sex determination to aid chorionicity assessment after 14 weeks, electronic documentation of chorionicity evidence, and the option to offer cell-free fetal DNA testing (NIPT) in monochorionic pregnancies following the updated NICE twin and triplet guidelines.

GTG No. 64 (new) -- Management of Thyroid Disorders in Pregnancy (April 2025): This new guideline addresses screening and management recommendations. Notably, it recommends propylthiouracil (PTU) over carbimazole for hyperthyroid women requiring treatment in pregnancy, with carbimazole being switched to PTU ideally before 10 weeks due to teratogenic risks. The guideline also recommends using trimester-specific and manufacturer-specific reference ranges for thyroid function tests.

Landmark Trials You Should Know

You do not need to memorise every trial ever published, but having a working knowledge of the biggest practice-changing studies is invaluable. Here is a concise overview of the trials that are most likely to come up:

The Big Baby Trial (2025): This is one of the most recent and hotly discussed UK trials. Published in The Lancet in May 2025, this UK multicentre RCT investigated whether induction of labour at 38+0 to 38+4 weeks reduces the risk of shoulder dystocia in pregnancies with a suspected large-for-gestational-age (LGA) fetus (estimated fetal weight above the 90th customised centile on ultrasound at 35--38 weeks). On intention-to-treat analysis, there was no statistically significant difference in shoulder dystocia between the two groups. However, 25% of the standard care group were also delivered early, which diluted the comparison. Another key limitation was the poor predictive value of ultrasound estimated fetal weight for actual LGA at birth. Nonetheless, the main takeaway appears to be that inducing labour early for a suspected big baby did not significantly reduce shoulder dystocia compared to standard care.

The ASPRE Trial (2017): Demonstrated that first-trimester screening for pre-eclampsia using the FMF algorithm (combining maternal factors, mean arterial pressure, uterine artery pulsatility index, and PAPP-A/PlGF) followed by aspirin 150mg at night from 11--14 weeks could reduce the incidence of preterm pre-eclampsia by 62%. This trial underpins the current approach to first-trimester pre-eclampsia screening and prophylaxis.

The PHOENIX Trial (2019): A UK multicentre RCT comparing planned delivery at 34--36+6 weeks versus expectant management in women with preterm pre-eclampsia. The trial found that planned delivery reduced maternal morbidity (composite of maternal adverse outcomes: 289 per 1000 in the planned delivery group vs 337 per 1000 in the expectant group) but with an expected increase in neonatal unit admissions. This trial directly informs the difficult decision about timing of delivery in preterm pre-eclampsia.

The Term Breech Trial (2000): Hannah et al. demonstrated that planned caesarean section for breech presentation at term significantly reduced perinatal mortality and serious neonatal morbidity compared with planned vaginal breech delivery. Despite its limitations and ongoing debate, this trial fundamentally changed practice and led to the predominance of caesarean delivery for term breech.

Additional Resources Worth Knowing

The Three Year Delivery Plan for Maternity and Neonatal Services (2023): Published by NHS England, this sets out the improvement plan for maternity services including workforce, perinatal leadership, culture change, and safety initiatives. It provides useful context for questions about the future direction of maternity care.

The APPG on Birth Trauma Report -- "Listen to Mums" (2024): This parliamentary report gathered testimony from over 1,300 women and exposed endemic issues with under-staffing, poor physical environments, harmful working culture, and a pattern of women's concerns being dismissed. It called for a National Maternity Improvement Strategy and a Maternity Commissioner.

NICE Guidelines: Make sure you are broadly familiar with the key NICE guidelines relevant to O&G, particularly those on intrapartum care (CG190), antenatal care (NG201), hypertension in pregnancy (NG133), twin and triplet pregnancy (NG137), and ectopic pregnancy and miscarriage (NG126).

Pulling It All Together

The volume of reading can feel overwhelming, but remember that interviewers will not assess your clinical knowledge and recall ability, just your sense of familiarity with what is happening in the specialty. Focus on understanding the key themes that run through all of these reports and guidelines: the centrality of patient safety, the persistence of health inequalities, the importance of multidisciplinary working and good communication, and the need for honest, reflective practice that learns from adverse outcomes.

When you are asked about a particular topic, try to weave in relevant evidence naturally. If asked about patient safety, you might reference the recurring themes from MBRRACE and the Ockenden and Kirkup inquiries. If asked about quality improvement, the Saving Babies' Lives Care Bundle and Each Baby Counts provide excellent frameworks for discussion regarding what you may want to work on in your trust.