ACOG Uses AHRQ Research in New Practice Bulletin on Episiotomy

Comparative Effectiveness
November 2006

The American College of Obstetricians and Gynecologists (ACOG) used AHRQ's Evidence Report, Use of Episiotomy in Obstetrical Care: A Systematic Review (No. 112), to spur development of an ACOG Practice Bulletin about episiotomy for its members. The AHRQ Evidence Report provided background research as well as clinical recommendations that ACOG used in developing the Bulletin.

The ACOG Practice Bulletin on episiotomy was issued in April 2006. According to Stanley Zinberg, MD, ACOG's Vice President of Practice Activities, ACOG provides its most important clinical recommendations to its members via Practice Bulletins.

"We issue an average of 10 bulletins a year, five in obstetrics and five in gynecology. Practice Bulletins summarize current information on techniques and clinical management issues for the practice of obstetrics and gynecology. They are included in our monthly journal, Obstetrics and Gynecology, and then put together in an annual compendium," Zinberg says. The journal reaches over 38,000 Fellows of the College of Obstetrics and Gynecology, with a total circulation of approximately 45,000.

ACOG has been long concerned with the issue of episiotomy. The use of episiotomies in routine births has been controversial for many years. According to the Evidence Report, "Despite several decades of research, which many interpret as definitive evidence against routine (or, liberal) use of episiotomy, little professional consensus has developed about routine use... Wide practice variations suggest that episiotomy use is heavily driven by local professional norms, experiences in training, and individual provider preference rather than variation in the physiology of vaginal births."

ACOG Practice Bulletins are developed through a standardized process overseen by an expert committee and include a review of the research and recommendations for clinical practice. Zinberg notes that, "Without the AHRQ Evidence Report, it is questionable whether or not we would have moved ahead with the assigning of the Practice Bulletin. Though we have our own resource center and sources of research which were used, the AHRQ Evidence Report was used extensively in the development of the Practice Bulletin. Our Practice Bulletin reflects many of the findings of your Evidence Report."

Impact Case Study Identifier: 
AHRQ Product(s): Effective Health Care Program
Topics(s): Women's Health
Geographic Location: National
Implementer: American College of Obstetricians and Gynecologists (ACOG)
Date: 11/01/2006


Use of Episiotomy in Obstetrical Care: A Systematic Review, Summary, Evidence Report/Technology Assessment Number 112. May 2005. AHRQ Publication No. 05-E009-1. Agency for Healthcare Research and Quality, Rockville, MD.


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