Obstetric Medicine > Volume 2, Number 2 > Pp. 63-66

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Original articles

Evidence-based medicine in obstetrics: can levels B and C recommendations be elevated to level A recommendations?

For the Evidenced-Based Medicine Obstetric Group:, Suneet P Chauhan MD   ^* , Eugene Chang MD   , Brian Brost MD   , Barbara Assel MD   ^*, Jason Baxter MD   , James A Smith, Jr. MD   ^**, Robert Grobman MD   , Vincenzo Berghella MD   , James A Scardo MD   , Everett F Magann MD    and John C Morrison MD   ^***

^* From Aurora Health Care, West Allis, WI; Medical University of South Carolina, Charleston, SC; Mayo Clinic, Rochester, MN; Thomas Jefferson University, Philadelphia, MD; ^** Stanford University Medical Center, Stanford, CA; Northwestern University Medical Center, Chicago, IL; Spartanburg Regional Medical Center, Spartanburg, SC; Portsmouth Naval Medical Center, Portsmouth, VA; ^*** University of Mississippi Medical Center, Jackson, MS, USA

Correspondence to: Suneet P Chauhan, MD, Aurora Health Care, 8901 W. Lincoln Avenue, PAC, West Allis, WI 53227, USA Email: suneet.chauhan{at}aurora.org

In this study, 65% (132/195) of level B/C obstetric recommendations are amenable to randomized clinical trials (RCTs) and seven were identified as most needed. The purpose of the survey was to evaluate levels B and C recommendations in obstetric practice bulletins (PBs) regarding the feasibility of performing RCT to elevate each subject to level A evidence. Eleven geographically dispersed physicians with experience in research reviewed levels B and C recommendations for the ethical and logistical feasibility of performing an RCT. In the 35 obstetric PBs, 195 level B/C recommendations were reviewed. The majority considered 47 (24%) topics unethical for an RCT and thought 16 (11%) did not need an RCT, thus leaving 132 (67%) levels B and C recommendations available for an RCT. Two-thirds of levels B and C recommendations in obstetric PB are amenable to RCTs and potentially becoming level A evidence.

Key Words: ACOG obstetric bulletins • randomized clinical trials

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