Evidence mapPaperPMID 41918447Full record

ArticleBJOG : an international journal of obstetrics and gynaecology2026

Assessment of Grades of Recommendations and Applicability of Royal College of Obstetricians and Gynaecologists Green-Top Guidelines: A Cross-Sectional Study.

Anangsha Kumar, Alexandra Cocking, Megan Hall, James Morris, Srividhya Sankaran, Holly Lovell, Andrew Shennan, Kypros Nicolaides, Lisa Story

Abstract read
In one paragraph

Article in BJOG : an international journal of obstetrics and gynaecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Anangsha KumarInstitute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Alexandra CockingDepartment of Women and Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Megan HallInstitute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.ORCID https://orcid.org/0000-0003-2756-6365
James MorrisDepartment of Obstetrics and Gynaecology, Cardiff and Vale University Health Board, Cardiff, UK.ORCID https://orcid.org/0000-0002-5040-9483
Srividhya SankaranDepartment of Women and Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Holly LovellDepartment of Population Health Sciences, King's College London, London, UK.
Andrew ShennanInstitute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Kypros NicolaidesInstitute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
Lisa StoryInstitute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.ORCID https://orcid.org/0000-0001-9328-9592

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRoyal College of Obstetricians and Gynaecologists (RCOG) Green-top Guidelines (GTGs) provide evidence-based recommendations in women's health. Even where evidence is considered high quality, it is uncertain whether factors known to influence maternity outcomes are reflected in study design.

objectivesTo determine distribution of recommendation grades across obstetric GTGs. For Grade A recommendations, to evaluate if supporting studies reported equity-relevant design features and methodological robustness.

designReview of RCOG obstetric GTGs.

settingUnited Kingdom. SAMPLE: All RCOG non-archived obstetrics GTGs published up to 20 April 2025.

methodsFrequencies of Grade A-D recommendations and Good Practice Points were recorded. For Grade A recommendations, underpinning studies were assessed for health equity and generalisability. All primary studies underpinning every Grade A recommendation were included; where a single study supported multiple recommendations, it was included every time and mapped to each relevant recommendation. The median health equity and generalisability score for each recommendation (if > 1 supporting studies) and a median score of all Grade A recommendations per guideline was calculated. MAIN MEASURE OUTCOMES: Distribution of recommendation grades: health equity and methodological robustness scores for studies underpinning Grade A recommendations.

resultsVariable frequencies of Grade A, B, C, D recommendations and GPP from 37 eligible guidelines were noted. Only 28 GTGs had Grade A recommendations, with median health equity and generalisability scores of 1 of 13 and 6 of 10 respectively across those recommendations.

conclusionsTwenty-four percent of obstetric GTGs have no Grade A recommendations. Of those that do, consideration of health equity and generalisability in associated studies is limited. These design and reporting features should be considered in future research to improve applicability of clinical guidance to all patient groups.

Indexed as

Evidence-Based MedicineGynecologyObstetricsPractice Guidelines as TopicCross-Sectional StudiesFemaleHumansPregnancySocieties, MedicalUnited Kingdomgeneralisabilityguidelineshealth equityobstetric

Identifiers

PMID41918447
PMCPMC13419000

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.