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Scientific Evidence Underlying the American College of Obstetricians and Gynecologists' Practice Bulletins

Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD; Lewin, Sharyn N. MD; Burke, William M. MD; Simpson, Lynn L. MD; Charles, Abigail S. MS; D'Alton, Mary E. MD; Herzog, Thomas J. MD

doi: 10.1097/AOG.0b013e3182267f43
Original Research

OBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College).

METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations.

RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.3%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049).

CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

LEVEL OF EVIDENCE: III

One third of the recommendations put forth by the American College of Obstetricians and Gynecologists in their Practice Bulletins are based on good and consistent scientific evidence.

From the Divisions of Gynecologic Oncology and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, and the Herbert Irving Comprehensive Cancer Center, New York, New York.

See related editorial on page 501.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 8th Floor, New York, NY 10032; e-mail: jw2459@columbia.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.