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Obstetric Recommendations in American Congress of Obstetricians and Gynecologists Practice Bulletins versus UpToDate:

Emily N B Myer1, Gloria T Too1, Ibrahim A Hammad1

  • 1Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia.

American Journal of Perinatology
|December 30, 2014
PubMed

Insights

Obstetric recommendations from the American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins and UpToDate (UTD) show significant differences. This incongruity may impact clinical practice and patient outcomes.

Area of Science:

  • Obstetrics and Gynecology
  • Clinical Practice Guidelines
  • Evidence-Based Medicine

Background:

  • Physicians rely on practice bulletins (PB) from the American Congress of Obstetricians and Gynecologists (ACOG) and UpToDate (UTD) for clinical recommendations.
  • Ensuring consistency between these authoritative sources is crucial for optimal patient care.

Purpose of the Study:

  • To compare the obstetric recommendations in ACOG practice bulletins (PB) with similar topics in UpToDate (UTD).

Main Methods:

  • Reviewed all obstetric ACOG PBs and cross-searched UTD from May 1999 to May 2013.
  • Analyzed PBs with corresponding UTD chapters and graded recommendations (A-C).
  • Two maternal-fetal medicine subspecialists assessed recommendation comparability (similar, dissimilar, incomparable) and calculated agreement statistics.

Main Results:

  • Identified 46 ACOG obstetric PBs and 86 UTD chapters.
  • UTD contained 50% fewer recommendations than ACOG PBs (181 vs. 365).
  • Significant differences (p < 0.001) were observed in the categorization of recommendations (Level A-C) between the two sources. Inter-rater agreement was moderate (kappa = 0.56).

Conclusions:

  • Incongruity exists between ACOG and UTD obstetric recommendations, potentially causing confusion for clinicians.
  • Harmonizing recommendations from ACOG and UTD could improve adherence and optimize obstetric outcomes.
Abstract

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