The Executive Desk: Collaboration and Learning, Everywhere
Hal C. Lawrence, MD, Executive Vice President and CEO
The coming of spring signifies a time of renewal and learning, with many professional and society meetings for ob-gyns and medical professionals everywhere. This includes the premier meeting for the ob-gyn specialty— the ACOG Annual Clinical and Scientific Meeting, May 2-6. Earlier in April, I had the honor and pleasure of being a part of ACOG’s annual delegation and attendance at the Japan Society of Obstetrics and Gynecology (JSOG). Meetings like these continue to be a great way to build relationships and ensure collaboration and learning, nationally and internationally.
ACOG Annual Meeting
We hope to see you at the annual meeting in just a few days!
Unable to attend the annual meeting in person? There are still a number of great ways to stay tuned-in to the meeting onsite:
Take Advantage of Virtual Educational & CME Opportunities
- The Virtual Meeting Annual Meeting allows digital access to meeting materials after the meeting including postgraduate courses, clinical seminars, lunch seminars, surgical tutorials, subspecialty sessions, and colloquia lectures. Check the Annual Meeting site for more information.
Read Articles about the Annual Meeting—Updates Available Daily
- The Annual Meeting Daily Newspaper offers daily articles and insights on every aspect of the meeting program.
Stay Connected with Social Media--What’s Happening LIVE at the Annual Meeting
Follow along on Twitter and Facebook for information and pictures from the annual meeting, regardless of whether or not you have an account.
- Follow the Meeting on Twitter: Follow @ACOG_AM for on-site live tweeting, from the President’s Program to the Convocation. Also follow #ACOG15 to see what everyone is saying about the meeting. (You don’t need a Twitter account to be able to view the tweets.)
- Like Our Annual Meeting Page on Facebook: Check out our active Facebook coverage at Facebook.com/AnnualMeeting, including photos of your ob-gyn colleagues on-sitea at the meeting
Japan Society of Obstetrics and Gynecology (JSOG) 2015
The 67th Annual Congress of the Japan Society of Obstetrics and Gynecology (JSOG) was held April 9-12, 2015 in Yokohama, Japan. As part of our ACOG/JSOG Exchange Program, six residents joined President John Jennings, Past President Jeanne Conry and EVP/CEO Hal Lawrence to share ideas and interact with leaders and young doctors from Japan, Taiwan and Korea. The residents and their districts are:
Karen Kwei, MD
Lindsey M. Davis, MD
Marlena Mattingly, MD
Amanda N. Thomas, MD
Kathleen Rooney, MD
Bernard Lynch, MD
The ACOG residents participated in poster sessions and gave talks on uterine myomas, assisted reproduction and preterm labor during the International Junior Fellows Workshop. Dr. Lynch was awarded an International Session Award for his presentation: “The prevalence of Lynch Syndrome-related mismatch repair mutations in a population of young endometrial cancer patients in South Texas” and Dr. Kwei won an International Session Good Poster Award for her poster “Umbilical Cord Blood Banking: Knowledge, Attitudes and Beliefs in a New Hampshire Cohort.”
Barney Lynch, Luke Newton, Amanda Thomas, Dr. Jennings, Karen Kwei, Dr. Lawrence, Marlena Mattingly, Dr. Conry, Kathleen Rooney, Lindsey Davis
After three busy days of seminars, JSOG treated the group to a trip to Kamakura to see the great Buddha.
We look forward to welcoming the JSOG delegation to San Francisco as part of the ACOG Annual Meeting.
Next year’s JSOG Congress will be held April 21-24, 2016, in Tokyo. Even-numbered districts will be invited to send one 3rd or 4th year resident. Please contact your District Manager or Catherine Sacks (email@example.com) for more information.
Presidents Blog: Help Educate Women to Drink Responsibly
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Presidents Blog: Continuing to Help Low-Income Women Access Primary Care
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President's Blog: ACOG - Our Strength is in Our Members
Serving as ACOG President is indeed an honor. It is also a significant responsibility involving accountability to the 58,000 members who pay dues to our organization.
Clinical Practice: April 2015 Practice Advisories
In the past month, the College has released two Practice Advisories to Fellows and the media. Practice Advisories are a relatively new source of ACOG clinical guidance that are issued ideally within 24-48 hours of the release of new emergent information on a clinical issue (e.g. clinical study, draft regulation) that is anticipated to generate a multitude of inquiries among Fellows and/or their patients.
ACOG Practice Advisory on Cell-Free DNA Screening, April 2, 2015
Based on a significant new study on cell-free DNA (cfDNA) screening, ACOG issued a Practice Advisory on a noninvasive prenatal screening method that uses the plasma of pregnant women. Although it has been seen as offering potential as a screening method for fetal aneuploidy, it had not yet been tested in low-risk pregnancies, as acknowledged in ACOG’s Committee Opinion 545 on Noninvasive Prenatal Testing for Fetal Aneuploidy. This new study examining its use in an unselected population, including a large group of "low risk" pregnancies, was published in the New England Journal of Medicine ("Cell-Free DNA Analysis for Noninvasive Examination of Trisomy,") April 1, 2015. To provide clinical guidance in response to the release of this new information, ACOG issued a Practice Advisory that can be found here. As ACOG reviews the Committee Opinion on cfDNA, we will take into account this study and others that have provided additional information about cfDNA screening in the general pregnant population.
ACOG Practice Advisory on Breast Cancer Screening, April 20, 2015
On April 20th, the U.S. Preventative Services Task Force posted a draft recommendation statement regarding breast cancer screenings, which will replace the 2009 guidelines. In the new recommendations, the Task Force comes closer to ACOG’s recommendations for women ages 40-49. While ACOG recommends annual mammograms in this age group, the Task Force now acknowledges that it is an individual decision that should take into account a woman’s risk factors, as well as potential harms and benefits. For a close comparison of ACOG versus Task Force draft guidelines, see our Practice Advisory, which can be found here.
-All Practice Advisories
-All Practice Bulletins
-All Committee Opinions
Events & Meetings: 2015 Annual Meeting Sure to Be a Winner
Are you ready to recharge your batteries, reconnect with colleagues and friends, and rededicate yourself to providing the very best health care to women?
All these things and much more are provided by ACOG’s 63rd Annual Meeting, May 2-6 in San Francisco, California. We hope you are all set to attend. If not, there is still time, but not much! You can register online here or on site in beautiful San Francisco. If you simply can’t attend, don’t forget about the Virtual Meeting. For $550, members can purchase access to recordings of colloquia, clinical seminars, subspecialty sessions, lunch seminars, and postgraduate courses.
The ACOG Annual Meeting also affords an opportunity to earn up to 31 CME credits. You can focus on the topics that mean most to you and earn CME credits every day.
Each day has a topical theme featuring a concentration of presentations:
- Saturday - Obstetric emergencies
- Sunday - Operative gynecology
- Monday – Contraception
- Tuesday – Menopause
- Wednesday – Patient safety and office practice
Annual Meeting has undergone many changes to become more effective for members, such as:
Don’t forget about the “tried and true” qualities that make the Annual Meeting highly effective and well-worth your time and money. Our power-packed agenda includes:
There is simply no better venue than the 2015 ACOG Annual Meeting to engage or reengage with our outstanding profession. The opportunities to learn from each other at the Annual Meeting are close to endless. If you’re unable to attend in person this year, make your plans to attend in 2016 in Washington, DC, May 14-18.
Patient Education: New Edition of Your Pregnancy and Childbirth: Month to Month
Updated Pregnancy Book Provides Trusted Content for Your Patients
Just in time for the Annual Meeting, the sixth edition of Your Pregnancy and Childbirth: Month to Month is here! Women read three to five books during their pregnancy, and this valuable resource from the experts at ACOG contains everything your patient needs to know about pregnancy and childbirth, from preconception to labor and delivery and beyond. Easy-to-understand text reinforces your guidance, giving your patient the most up-to-date information available. Information is presented in a balanced, reassuring tone to help patients make informed decisions about their preconception care, pregnancy care, labor and delivery, the postpartum period, and beyond.
What’s in the Book?
The first half of the book is a month-to-month guide, which moms-to-be can use to learn how their babies are developing during each month of pregnancy. Accompanied by full-color illustrations, the book includes information about how a pregnant woman’s body changes each month, nutrition and exercise tips by month, and other special concerns that a woman may have during her pregnancy. The second half of the book addresses specific topics related to pregnancy and childbirth, from multiple pregnancy to genetic disorders.
New and Updated Content
To address key reader feedback, the sixth edition includes new or updated information on the following:
- Pain relief during labor
- Problems during labor and delivery
- Reducing the risk of birth defects
- Screening and diagnostic testing for genetic birth defects
- Breastfeeding and formula-feeding, including discussion of some of the challenges of breastfeeding
- The latest information about vaginal birth after cesarean delivery, preeclampsia, and labor induction
Valued by Ob-Gyns Who Provide the Book to Their Patients
Many Fellows report putting together care packages for their newly pregnant patients at this exciting time. Your Pregnancy and Childbirth spurs understanding and knowledgeable questions from patients. Whether continuing or starting the tradition to provide this book to your patients, order the pregnancy book today in bulk at the member discount rate and save.
Stop by the ACOG booth —#1217—at the annual meeting to flip through and receive a sample copy! Learn more about the book here.Encourage your patients to follow @ACOGPregnancy on Twitter.
Advocacy & Health Policy: If You Have, Give; If You Need, Seek
Dr. Chinula with mentor Dr. Diaz-Arrastia
There is a Malawian proverb that says, “If you have, give; if you need, seek.” ACOG’s most recent Global Health Scholar, Dr. Lameck Chinula, a junior faculty member from Kamuzu Central Hospital in Lilongwe, Malawi, is the personification of this philosophy.
When asked what he had gained from his four week Global Health Scholar experience, Dr. Chinula said that his U.S. experiences “…gave me a unique opportunity to reflect on my own personality, management style, and especially on my ability to communicate and advocate.” Dr. Chinula plans to use this knowledge to shape his work at the hospital, his university responsibilities and his interactions with health officials in Llongwe. In addition to his duties as a physician and instructor, Dr. Chinula is the secretary for Malawi’s fledgling Ob-Gyn Association.
Dr. Chinula and GWH Staff at ACOG
The ACOG Global Health Scholars Program as envisioned by ACOG and our funder, Johnson & Johnson, is a bi-directional collaboration between an American university and a low-resource country ob-gyn department/residency program. The first exchange involved Texas Children’s Hospital/Baylor College of Medicine and Kamuzu Central Hospital in Llongwe, Malawi. Dr. Bridget Kelly went to Malawi in January 2015 through this partnership. At the end of February 2015, Dr. Chinula traveled to the United States for one month to sharpen his leadership, advocacy, management, communication and team-building skills.
Dr. Chinula began his scholar experience at the ACOG Robert C. Cefalo National Leadership Institute in North Carolina. This intensive five-day program was crafted to give physicians instruction on advocacy, communication, media relations, teamwork, and executive leadership.
Next on his itinerary was the annual meeting of the Council on Resident Education in Obstetrics and Gynecology/Association of Professors of Gynecology and Obstetrics (CREOG/APGO). This gathering of over 1,000 ob-gyn faculty from many settings, provided sessions on pre-service and in-service education, simulation as training methodology, and the overall structure of residency education.
Dr. Susan Raine from Baylor College of Medicine then accompanied Dr. Chinula at the Texas Children’s Hospital’s International Colloquium. This conference brings together, from across the world, individuals and programs that conduct HIV/AIDS research to share findings and best practices.
Finally, towards the end of his itinerary, Dr. Chinula participated in in a one-week rotation with the head of cervical oncology at Baylor College of Medicine. Dr. Chinula’s clinical observation period about cervical cancer will be one of the most relevant parts of his journey since Malawi has the highest rate of cervical cancer in Africa.
Dr. Chinula with BCM mentors Drs. Raine and Sclafani
After this unique experience with several organizations and communities, Dr. Chinula, junior faculty, researcher, gynecologic surgeon, obstetrician, secretary of the Malawi Ob-Gyn Association, husband and father, is well-positioned to share his experiences in leadership, as well as mentor other young ob-gyns and residents in the newly formed university residency training program, the young Ob-Gyn Association, as well as with faculty at Kamuzu Central Hospital. We look forward to an on-going relationship with Dr. Chinula and to hearing how he is sharing his knowledge with others, and working to help improve healthcare for the women of Malawi.
Advocacy & Health Policy: After Over 15 Year Fight, Flawed Medicare SGR Replaced
Medicare’s Sustainable Growth Rate (SGR) formula is no more! After over a decade of threatening physicians with double digit payment cuts, ACOG, its members, and the physician community successfully pushed Congress to replace this failed policy.
What exactly is in the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015? First, it is very similar to H.R. 4015/S 2000 from the 113th Congress – bipartisan, ACOG-supported legislation that was a top ask at ACOG’s 2014 Congressional Leadership Conference. To learn more about the nuts and bolts of the bill, click here.
ACOG has been hard at work ensuring that ob-gyns were at the table from the start. You can see ACOG’s particular imprint on the new law, and the many ways ACOG worked to make sure it works for its members, in the highlights below.
This truly is a watershed moment for ob-gyns and our patients.
Dr. Jennings and Sue Ellen celebrate SGR Repeal
Top ACOG Wins:
- Reliable Payment Increases for the First Five Years: Ensures a period of stability with modest Medicare payment increases for five years, plus no cuts with opportunity for payment increases for the next five years.
- Protection for Low Medicare Volume Physician Practices: Ob-gyns and other physicians with a small Medicare patient population are exempt from many program requirements and penalties.
- Physician Liability Protections: Ensures that federal quality measurements cannot be used to imply medical negligence and generate lawsuits.
- Protected Ultrasound: No cuts to ultrasound reimbursement.
- Penalties Ended: Penalties related to Electronic Health Records (EHR) Meaningful Use, Physician Quality Reporting System, and use of the Value-Based Modifier end in 2018.
- Alternative Payment Model (APM) Bonus Payments: Bonus-eligibility for APM participation is based on patient volume, not just revenue, to make it easier for ob-gyns to qualify.
- Children’s Health Insurance Program (CHIP): Includes a 2-year extension of program that provides comprehensive coverage to hundreds of thousands of pregnant women and millions of adolescent girls across the country.
- Quality Measure Development: Helps professional organizations, like ACOG, develop quality measures for the Merit-Based Incentive Payment System (MIPS), rather than being developed by a federal agency, ensuring that this new program works for physicians.
- Stops CMS Policy on Global Surgical Codes: Halts implementation of Center for Medicare and Medicaid Services plan to unbundle all 10- and 90-day global codes, and ensures instead a thorough, data-driven approach to appropriately valuing surgical services, including those provided by ob-gyn subspecialists, such as urogynecologists and gynecologic oncologists.
- Extension of Key Programs of Importance to Ob-gyn: Funding extensions to Medicaid/CHIP Pediatric Quality Measures Program, Community Health Centers, National Health Service Corps, and Teaching Health Center Graduate Medical Education Payment Program.
Modern Healthcare Recognizes Leader of ACOG’s Health Policy Division
Barbara S. Levy, MD, ACOG Vice President of Health Policy, has been named as one of Modern Healthcare’s 50 Most Influential Physician Executives and Leaders.
Through its Awards and Recognition program, Modern Healthcare pinpoints individuals from all sectors of the health industry and allows readers of Modern Healthcare to vote for the leaders who they believe to have had the most influence. In this year's ranking, Modern Healthcare focused on leaders who have been especially influential in the improving of patient safety and quality of care. Also, this year, Dr. Levy is one of nine women included in the top 50 ranking.
In addition to her ACOG responsibilities, Dr. Levy is the chair of the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC). In ACOG's April 6, 2015 press release, Dr. Levy comments: “I am honored and humbled to be recognized by Modern Healthcare as a physician leader. As an obstetrician-gynecologist for 30 years, I have come to believe that caring for women means advocating for their access to quality care, and it means teaching America’s future women’s health care providers. I look forward to my continued work with ACOG to expand our leadership role in promoting quality health care for women.”
Click here for more information on the Modern Healthcare awards.
Advocacy & Health Policy: ACOG Partners with SAHMSA on National Prevention Week 2015
ACOG has partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to support National Prevention Week, an annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues. National Prevention Week 2015 will take place May 17-23, 2015.
This year’s National Prevention Week consists of seven days, each day with its own theme. One of ACOG’s 2015 legislative priorities is supporting appropriate efforts to reduce maternal opioid dependence, including:
- Promoting public health efforts to reduce maternal opioid dependence and neonatal abstinence syndrome (NAS)
- Opposing punitive legislation against women with opioid dependence and babies born with NAS
Deaths from prescription painkiller overdoses increased more than 400% between 1999 and 2010, with nearly 48,000 women dying of prescription painkiller overdoses during that period. The nonmedical use of prescription drugs, particularly opioids, sedatives, and stimulants, has been cited as an epidemic in the United States, accounting for increasing numbers of emergency department visits and deaths from reactions and overdoses. Chronic untreated of some opioids during pregnancy greatly increases the risk of fetal growth restriction, placental abruption, preterm labor, and fetal death. Conversely, opioid withdrawal without treatment also raises the risk of fetal death.
ACOG has developed the following resources to assist clinicians:
For more information on ACOG resources, please contact firstname.lastname@example.org
Membership & Fellowship: Career Connection
‘Career Connection’ Online Job Board and In-Person Annual Meeting Career Fair: Match Made in Heaven
We all know ACOG’s Career Connection is the best place to go for new career opportunities for ob-gyns and allied professionals. It works just as well for your first opportunity out of residency as it does for a mid-career change.
ACOG’s Career Connection is a great place to browse available jobs, set up search alerts so job opportunities are delivered to you, post your resume or CV so employers find you, and manage the entire job search process.
But, did you know that the Career Fair at the ACOG Annual Meeting, May 2-6, San Francisco, California, is the best place to meet face-to-face with potential employers? Register now for the ACOG Career Fair. It is free for attendee job seekers and is your best opportunity to get up close and personal with employers currently hiring ob-gyns.
- Meet face-to-face with ob-gyn employers
- Learn more about many great employers exhibiting at this event
- Walk away with new contacts and potential job opportunities
Current List of Employers (Check back later for an updated list of attending employers!)
- Arlington Women's Center, PLLC
- Billings Clinic
- Charles B. Wang Community Health Center
- College Hill Women's Health Center
- Community Health Systems
- Comp Health
- Essentia Health
- Florida Hospital Orlando
- Geisinger Health System
- Harvard Vanguard
- Jackson & Coker
- Kaiser - Southern California Permanente Medical Group
- Labette Health
- Marshfield Clinic
- Mercy Clinic
- Ministry Health Care
- OB Hospitalist Group
- Presence Medical Group
- Providence Health & Services
- Spectrum Health
- WellHealth Medical Group
- Women's Health Associates of Southern Nevada
Thank you to our Gold Sponsors: Providence Health & Services, WellHealth Medical Group, Ezras Cholilim Health Care, and TeamHealth
Need to hire for the ob-gyn specialty? Learn more about ob-gyn career sponsor opportunities.
Be sure to visit the Career Connection booth at the Annual Meeting to search jobs, set up job alerts, post a resume, and receive a free CV review.
ACOG serves as an expert information source about women’s health for women and the media. The organization’s Office of Communications regularly receives media inquiries from newspapers, magazines, websites, radio, and TV broadcast outlets. In many cases, ACOG officers and members talk with the media, working with the Office of Communications. Here are several recent pieces in the media that prominently featured ACOG guidance and experts. We’ve included excerpts and links to the original articles.
District Newsletters: District VII Spring 2015
In this issue: Chair's Report: District VII Storms the Capital; Hollis Fellowship: A District VII Unique Program in Mentorship; Teen Pregnancy Update, Junior Fellow Report; Young Physicians Report; Program Chair Report; Section Reports
ACOG in the News: Endometrial Cancer Hints, Baby Fat, The Great Sibling Debate, and Angelina Jolie
MSNBC New laws force doctors to lie to patients about abortion
“Evidence and science must guide the care that patients receive in any area of medicine. When political agendas get in the way of that, patients suffer.” Opinion piece by Dr. John C. Jennings and Dr. Nancy L. Stanwood
Reuters New U.S. mammogram guidelines stick with screening from age 50
Many groups, including the American College of Obstetrics and Gynecology (ACOG) and the American College of Radiology, recommend annual mammograms start at age 40. The American Cancer Society shares that view, but is reviewing its guidelines.
The health panel's updated recommendations are now "more closely in line with ACOG’s," said Dr. John Jennings, ACOG president. Both groups recognize that the decision to screen women in their 40s is a personal one that reflects potential benefits of detecting cancer early and the harm of receiving a false positive, he said.
Medscape Doctors Applaud SGR Bill's Malpractice Protection
The American College of Obstetricians and Gynecologists (ACOG) also heralded the measure but said it doesn't go far enough to protect doctors from malpractice suits. When asked for a statement, ACOG replied in an email: "ACOG is pleased that a provision in the SGR package was included to address standard of care protection, and continues to support prompt passage of SGR repeal legislation."
"We will continue to seek comprehensive and alternative medical liability reforms, and we hope that Representatives Barr and Bera reintroduce their 'safe harbor' bill soon," ACOG said. "Their legislation, the Saving Lives, Saving Costs Act, would improve quality of care by promoting physician adherence to clinical practice guidelines, and would also help to avoid frivolous lawsuits, lowering overall health care costs and ensuring that physicians can continue to treat their patients."
Contemporary Ob-Gyn Team Up for Women’s Health at ACOG’s Annual Meeting in San Francisco
The theme of ACOG’s 2015 Annual Clinical and Scientific Meeting is “Teaming Up for Women’s Health.” It will be held May 2-6 in San Francisco’s Moscone Convention Center.
The clinical themes are: obstetric emergencies (Saturday); operative gynecology (Sunday); contraception (Monday); menopause (Tuesday); and patient safety and office practice (Wednesday).
US News & World Report CDC: Teens Unfamiliar With Most Effective Form of Birth Control
Dr. Hal Lawrence, CEO and executive vice president for the American College of Obstetricians and Gynecologists said in a statement that the organization supports "unhindered and affordable access to all forms of contraception."
"Today's CDC data demonstrate that when contraception is affordable, the impact on the lives of American women is real," he said.
Medscape Guidance Issued for Endometrial Cancer, Hints for Diagnosis
The American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncology have issued new guidance for endometrial cancer. The practice bulletin was published in the April issue of Obstetrics & Gynecology.
"A thorough understanding of the epidemiology, pathophysiology, and diagnostic and management strategies for this type of cancer allows the obstetrician–gynecologist to identify women at increased risk, contribute toward risk reduction, and facilitate early diagnosis," the bulletin states.
Detroit Free Press What's that? Pregnancy Terms to Know
Sources: "Your Pregnancy & Birth, Fourth Edition" by the American College of Obstetricians and Gynecologists ($14.95, Meredith Books)
Detroit Free Press Baby fat: Why You Shouldn't Eat For 2 During Pregnancy
A too-big baby, known medically as fetal macrosomia, weighs 4,000-4,500 grams at birth — or 8 pounds, 13 ounces-9 pounds, 4 ounces — according to the American College of Obstetricians and Gynecologists.
Sacramento Bee Urinary Incontinence Problematic for Many women Over 40, Study Finds
New guidelines on urinary incontinence from the American College of Physicians urge doctors to recommend nonmedicated treatment options for women whenever possible. These include bladder training for those with urge incontinence complemented by Kegel exercises, weight loss, and minimizing bladder irritants such as caffeine, spicy foods, alcohol and citrus fruits.
HealthDay Is Gestational Diabetes Linked to Autism?
Under guidelines from the American College of Obstetricians and Gynecologists, women are screened for gestational diabetes, usually at 24 to 28 weeks. A woman who has risk factors for gestational diabetes -- such as being overweight, older than 25 or having a history of gestational diabetes -- should consider earlier screening, such as at the first prenatal visit, Xiang said.
Yahoo Parenting How Close in Age Should Siblings Be? The Great Debate
The American College of Obstetricians and Gynecologists (ACOG) suggests waiting at least 12 months to conceive after the birth of a child to reduce the risk of preterm birth and low birth weight. That’s because women’s bodies need time to recover from one pregnancy and delivery in order to enter the next one in optimal health.
The Miami Herald Angelina Jolie is Saving Women’s Lives
According to the American College of Obstetrics and Gynecology, all tissue from the ovaries and fallopian tubes should be removed, and a complete, serial sectioning that includes microscopic examination for occult cancer should be conducted.
National Journal The Big Battle Over a Little Device
Throughout the 1980s and '90s, most American medical students never learned to insert an IUD—even as a host of studies from European countries, where IUDs had remained popular, suggested the new models were safe. If doctors did recommend them for women, it was for a narrow category who were "older, married, with several children," says Eve Espey, chair of the Long-Acting Reversible Contraception Work Group at the American College of Obstetricians and Gynecologists. In part, providers couldn't shake their fear, after the Dalkon Shield, of leaving young women infertile—and of inviting lawsuits as a consequence.