Am J Perinatol 2015; 32(05): 427-444
DOI: 10.1055/s-0034-1396684
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Emily N. B. Myer
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Gloria T. Too
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Ibrahim A. Hammad
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Shilpa Babbar
2  Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
,
Charley E. Martin
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
James B. Hill
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Sean B. Blackwell
3  Department of Obstetrics and Gynecology, University of Texas-Houston, Houston, Texas
,
Suneet P. Chauhan
1  Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
› Author Affiliations
Further Information

Publication History

11 April 2014

02 October 2014

Publication Date:
29 December 2014 (eFirst)

Abstract

Objective To compare the obstetric recommendations in American Congress of Obstetricians and Gynecologists (ACOG) practice bulletins (PB) with similar topics in UpToDate (UTD).

Study Design We accessed all obstetric PB and cross-searched UTD (May 1999–May 2013). We analyzed only the PB which had corresponding UTD chapter with graded recommendations (level A–C). To assess comparability of recommendations for each obstetric topic, two maternal–fetal medicine (MFM) subspecialists categorized the statement as similar, dissimilar, or incomparable. Simple and weighted kappa statistics were calculated to assess agreement between the two raters.

Results We identified 46 ACOG obstetric PB and 86 UTD chapters. There were 50% fewer recommendations in UTD than in PB (181 vs. 365). The recommendations being categorized as level A, B, or C was significantly different (p < 0.001) for the two guidelines. While the overall concordance rate between the two MFM subspecialists was 83% regarding the recommendations for the same topic as similar, dissimilar, or incomparable, the agreement was moderate (kappa, 0.56; 95% confidence intervals, 0.48–0.65).

Conclusion Though obstetricians have two sources for graded recommendations, incongruity among them may be a source of consternation. Congruent recommendations from ACOG and UTD could enhance compliance and potentially optimize outcomes.

Note

The study was presented as an oral presentation at the Central Association of Obstetricians and Gynecologists 2013 Annual Meeting at Napa, California, October 16 to 19, 2013.