Uptake of meta-analytical overviews of effective care in English obstetric units

To establish the current availability of meta-analytical overviews of effective care in perinatal medicine, in the form of Effective Care in Pregnancy and Childbirth and the Oxford Database of Perinatal Trials, in English obstetric units and to find out how obstetricians without either one keep up to date.

Standardised telephone questionnaire.

The consultant obstetrician deemed to be the Royal College of Obstetricians and Gynaecologists' administrative contact in each of the 24 teaching hospitals, and in 74 of 173 (43%) district general hospitals in England.

Knowledge and use of Effective Care and the Oxford Database in the obstetric unit.

Thirty-seven percent of units did not have access to either Effective Care or the Oxford Database, with significant differences between district general hospitals and teaching hospitals in lack of availability (33/74 (45%) versus 3/24 (12%) respectively, P = 0.02). Effective Care was available in 51% of district general hospitals and 79% of teaching hospitals, compared with the availability of the Oxford Database which was only available in 16% and 62%, respectively. Reasons given for not obtaining either included non-awareness, expense, and perceived lack of need. The consultants with neither Effective Care nor the Oxford Database claimed to keep up to date by various methods, usually as information from colleagues.

These results reflect both inefficient dissemination of medical knowledge in obstetrics and the reluctance of obstetricians to consider adapting their practice as a result of evidence from meta-analyses of randomised controlled trials. Although Effective Care is more widely available than the Oxford Database, its datedness renders it inferior to the database as a means of facilitating effective care in obstetrics.