References Supporting Recommendations in Obstetrical Green Top Guidelines: An Overview of RCOG Clinical Guidelines

Area of Science:

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

Background:

• The Royal College of Obstetrics and Gynecology (RCOG) issues Green-top Guidelines (GTGs) to standardize clinical practice.
• Previous analyses indicate a deficiency in high-grade evidence, such as randomized clinical trials (RCTs), supporting many clinical recommendations.

Purpose of the Study:

• To descriptively evaluate the quality of evidence underpinning obstetrical recommendations within RCOG's Green-top Guidelines (GTGs).
• To assess the proportion of RCOG GTG recommendations supported by high-quality evidence and RCTs.

Main Methods:

• A review of RCOG obstetrical GTGs available as of September 2024.
• Each citation was cross-referenced in PubMed to determine its status as a randomized clinical trial (RCT).
• Data were recorded and summarized, with a random 10% sample verified by the senior author.

Main Results:

• Of 1,861 RCOG obstetrical recommendations, 69% cite references, but 43% are based on non-analytical studies or expert opinion.
• Only 9% of RCOG recommendations meet Grade A standards (high-quality evidence).
• Evidence Level 1++ (highest quality) was found in 5% of cited references, and only 7% originated from RCTs.

Conclusions:

• A significant portion of RCOG obstetrical guidelines rely on lower-quality evidence, including expert opinion.
• There is a clear need for increased high-quality evidence, particularly from RCTs, to support obstetrical recommendations.
• Further research is warranted to enhance evidence-based practices in obstetrics and gynecology.