title: Evidence-based medicine in obstetrics: can levels B and C recommendations be elevated to level A recommendations?
abstract: 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.
authors: Aurora Health Care , West Allis, WI.
authors: Suneet P
authors: SP
authors: Chauhan
authors: Medical University of South Carolina, Charleston, SC.
authors: Eugene
authors: E
authors: Chang
authors: Mayo Clinic , Rochester, MN.
authors: Brian
authors: B
authors: Brost
authors: Aurora Health Care , West Allis, WI.
authors: Barbara
authors: B
authors: Assel
authors: Thomas Jefferson University , Philadelphia, MD.
authors: Jason
authors: J
authors: Baxter
authors: Stanford University Medical Center , Stanford, CA.
authors: James A
authors: JA
authors: Smith
authors: Northwestern University Medical Center , Chicago, IL.
authors: Robert
authors: R
authors: Grobman
authors: Thomas Jefferson University , Philadelphia, MD.
authors: Vincenzo
authors: V
authors: Berghella
authors: Spartanburg Regional Medical Center , Spartanburg, SC.
authors: James A
authors: JA
authors: Scardo
authors: Portsmouth Naval Medical Center , Portsmouth, VA.
authors: Everett F
authors: EF
authors: Magann
authors: University of Mississippi Medical Center , Jackson, MS , USA.
authors: John C
authors: JC
authors: Morrison
keywords: ACOG obstetric bulletins; randomized clinical trials