Featured Committee Opinion: 671 Perinatal Risks Associated With Assisted Reproductive Technology
In an updated Committee Opinion, ACOG evaluates the most up-to-date data on outcomes using assisted reproductive technology (ART), specifically focusing on IVF. Health care providers must be prepared to discuss the benefits and risks of ART with patients who are considering the procedure. Some risks of ART include multifetal gestations, prematurity, low birth weight, small for gestational age, perinatal mortality, caesarean delivery, preeclampsia, and birth defects. The greatest risk is the occurrence of multifetal pregnancies, which can produce complications for the health of both mother and fetuses, including increased fetal morbidity. Low-dose stimulation protocols, close monitoring of hormone levels and follicle numbers during superovulation cycles, and giving patients the option of elective single embryo transfers (eSET) are several methods of limiting the number of multifetal pregnancy.
“Over the past decades our understanding and capability around ART have come a long way,” said Dr. Joseph Wax, chair, Obstetrics Practice, ACOG. “While multifetal pregnancy is a commonly associated risk with ART, it is increasingly preventable. Reducing this possibility not only protects mother and fetus, but ultimately increases the likelihood that patients achieve their goal of a healthy and successful pregnancy.”
Committee Opinion Number 671: Perinatal Risks Associated With Assisted Reproductive Technology is available in the September 2016 issue of Obstetrics and Gynecology.
Featured Practice Advisory: FDA Issues Updated Fluoroquinolone Warning
A new Practice Advisory from ACOG advises that oral and injectable fluoroquinolones should only be used to treat serious bacterial infections and uncomplicated urinary tract infections in patients who have no other treatment options. This comes from a Drug Safety Communication by the Food and Drug Administration (FDA), which states that the risks of serious adverse effects of using oral and injectable fluoroquinolones generally outweigh the benefits. These medications are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient. As a result, the FDA has revised the Boxed Warning, he FDA’s strongest warning, to address these safety issues.
Read the full Practice Advisory: FDA Issues Updated Fluoroquinolone Warning, which was released August 4, 2016.
Read the complete FDA Drug Safety Communication
Featured Updated Practice Advisory: Zika Virus
ACOG updated its Practice Advisory on the Zika Virus following new information from the Centers from Disease Control and Prevention (CDC). This new information includes a travel warning, advising that pregnant women and their partners should not travel to areas with ongoing Zika outbreaks, including Puerto Rico, and specific areas in Florida. The Practice Advisory maintains that women who are considering pregnancy should discuss the advisability of travel with their obstetric providers. When traveling to these areas, women should use precautions day and night to avoid mosquito bites, including EPA-approved bug spray with DEET, cover any exposed skin, stay in air-conditioned or screened-in areas, and treat clothing with permethrin. Couples in areas without active Zika transmission should also follow the CDC’s recommendations for prevention of sexual transmission, even if they are not pregnant or planning to get pregnant.
There are many unknowns about Zika, but new information develops on a weekly and sometimes daily basis. All pregnant women in the United States and US territories should be assessed for possible Zika exposure at each prenatal visit.
Read the full Practice Advisory: Zika Virus, updated August 3, 2016.
ACOG helps you stay informed of the latest Zika information:
ACOG’s Zika webpage
ACOG/SMFM Practice Advisory on Zika
CDC Zika Virus Website
State Health Department Contact list for ob-gyns (members only) for questions on CDC’s Zika Registry
State Health Department Contact list for ob-gyns (members only) for questions on testing
CDC Zika Pregnancy Hotline for Healthcare Providers: Ob-gyns can contact the CDC Zika Pregnancy Hotline at 770-488-7100 or email ZikaPregnancy@cdc.gov for any concerns related to clinical management or the US Zika Pregnancy Registry
Obstetric Care Consensus: Severe Maternal Morbidity: Screening and Review
A joint Obstetric Care Consensus from ACOG and the Society for Maternal-Fetal Medicine proposes new guidance on the screening and review of maternal morbidity. The Consensus details a two-step screen and review process intended to detect severe maternal morbidity in pregnant women. The two criteria to screen for severe maternal morbidity are transfusion of 4 or more units of blood and admission of a pregnant or postpartum woman to an ICU. It is also recommended that facilities review all cases that meet at least one of these screening criteria to determine whether the case is truly a severe maternal morbidity. After review of the events, diagnoses, and outcomes involved, it can be determined if an identified morbidity was potentially avoidable. This presents the opportunity for system change and improved future performance.
Read the full Obstetric Care Consensus: Severe Maternal Morbidity: Screening and Review, published September 2016.