ACOG New and Updated Publications

Cholesterol and Your Health

resources@acog.org — Fri, 17 May 2013 16:37:00 -0400

Cholesterol is a natural substance that serves as a building block for cells and hormones. A certain amount is good for you. But, excess cholesterol can stick to the walls of vessels, making it harder for blood to move through them. Sometimes cholesterol blocks an artery. Then, the body part served by the artery cannot receive needed nutrients or oxygen. A heart attack can occur if an artery is blocked in the heart. If the blockage is in the brain, a stroke can result.

Benefits and Risks of Sterilization

resources@acog.org — Fri, 17 May 2013 11:30:23 -0400

Female and male sterilization are both safe and effective methods of permanent contraception used by more than 220 million couples worldwide (1). Approximately 600,000 tubal occlusions and 200,000 vasectomies are performed in the United States annually (2–4). For women seeking permanent contraception, sterilization obviates the need for user-dependent contraception throughout their reproductive years and provides an excellent alternative for those with medical contraindications to reversible methods. The purpose of this document is to review the evidence for the safety and effectiveness of female sterilization in comparison with male sterilization and other forms of contraception.

Fetal Growth Restriction

resources@acog.org — Fri, 17 May 2013 11:29:45 -0400

Fetal growth restriction, also known as intrauterine growth restriction, is a common complication of pregnancy that has been associated with a variety of adverse perinatal outcomes. There is a lack of consensus regarding terminology, etiology, and diagnostic criteria for fetal growth restriction, with uncertainty surrounding the optimal management and timing of delivery for the growth-restricted fetus. An additional challenge is the difficulty in differentiating between the fetus that is constitutionally small and fulfilling its growth potential and the small fetus that is not fulfilling its growth potential because of an underlying pathologic condition. The purpose of this document is to review the topic of fetal growth restriction with a focus on terminology, etiology, diagnostic and surveillance tools, and guidance for management and timing of delivery.

Disorders of the Vulva

resources@acog.org — Thu, 16 May 2013 16:08:41 -0400

Certain health problems can affect the vulva. Itching and pain are the two most common symptoms of a vulvar disorder. There also may be changes on the skin of the vulva. Some problems are short term and easy to treat. Other problems can be long term and require ongoing treatment and follow-up.

Elective and Risk-Reducing Salpingo-oophorectomy

resources@acog.org — Wed, 15 May 2013 08:54:31 -0400

In the United States, 600,000 hysterectomies are performed annually, of which one half include salpingo–oophorectomy (1). Salpingo–oophorectomy is performed electively at the time of hysterectomy to decrease the risk of ovarian cancer and to avoid possible morbidities and future surgery related to benign ovarian neoplasms, endometriosis, and pelvic pain.

There is a subset of women with an elevated risk of ovarian carcinoma and breast carcinoma recurrence who are candidates for risk–reducing salpingo–oophorectomy performed for the primary purpose of reducing breast, ovarian, and fallopian tube carcinoma risks. The purpose of this document is to provide a framework for counseling women about the benefits and risks of elective salpingo–oophorectomy at the time of hysterectomy and to provide some guidelines for risk–reducing salpingo–oophorectomy.

Ovid Member Access

Tue, 14 May 2013 11:02:17 -0400

January-February 2007 Supplement

resources@acog.org — Fri, 10 May 2013 10:44:42 -0400

SPECIAL REPORT FROM ACOG: Breastfeeding: Maternal and Infant Aspects

Benign Breast Problems and Conditions

resources@acog.org — Thu, 02 May 2013 13:05:20 -0400

Many women have benign breast conditions that cause lumps and other symptoms in the breasts. They often go away on their own or they can be treated with medication or minor surgery.

Colposcopy

resources@acog.org — Thu, 02 May 2013 13:04:17 -0400

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light onto the vagina and cervix. A colposcope can enlarge the normal view by 2–60 times. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

Breastfeeding Your Baby

resources@acog.org — Wed, 01 May 2013 16:11:47 -0400

More and more women are choosing to breastfeed their babies—and for good reason. Breast milk provides the perfect mix of vitamins, protein, and fat that your baby needs to grow. It also protects your baby against certain diseases. Although some women may not be able to breastfeed for a variety of reasons, for most women, breastfeeding (or “nursing”) is the best way to feed their babies.

Natural Family Planning

resources@acog.org — Mon, 29 Apr 2013 16:33:13 -0400

Natural family planning is a form of birth control that is based on the timing of sex during a woman’s menstrual cycle. Natural family planning used to be called the rhythm method. It also is called periodic abstinence or, more recently, fertility awareness. It is not a single method but a variety of methods.

Weight Control: Eating Right and Keeping Fit

resources@acog.org — Fri, 26 Apr 2013 13:13:54 -0400

A healthy weight is good for your physical and mental well-being. Good eating habits and moderate exercise are crucial to keeping a healthy weight and a fit body. Being overweight—weighing too much in relationship to your height—is a problem for many people. If you are overweight, you have an increased risk of several health problems. The good news is that you can reduce these risks by losing weight.

Postpartum Hemorrhage From Vaginal Delivery

resources@acog.org — Mon, 22 Apr 2013 16:48:40 -0400

The Patient Safety Checklist on Postpartum Hemorrhage From Vaginal Delivery should be used to guide the process if a patient who is undergoing vaginal delivery experiences an estimated blood loss greater than 500 mL.

Ethical Issues With Vaccination for the Obstetrician–Gynecologist

resources@acog.org — Mon, 22 Apr 2013 16:25:42 -0400

ABSTRACT: Because of the growing importance of infectious disease prevention in the individual patient and the larger community, it is vital that Fellows of the American College of Obstetricians and Gynecologists be prepared to navigate the practical and ethical challenges that come with vaccination. Health care professionals have an ethical obligation to keep their patients’ best interests in mind by following evidence-based guidelines to encourage patients to be vaccinated and to be vaccinated themselves. College Fellows should counsel their patients about vaccination in an evidence-based manner that allows patients to make an informed decision about the use of these agents in their health care. The Centers for Disease Control and Prevention reports that no evidence exists of risk to the fetus from vaccinating pregnant women with noninfectious virus or bacterial vaccines or toxoids. Mandatory vaccination of health care professionals may be an ethically justified strategy in cases in which the harm to patients and the general population is believed to outweigh the autonomy of individual physicians.

Ethical Issues in Pandemic Influenza Planning Concerning Pregnant Women

resources@acog.org — Mon, 22 Apr 2013 16:25:05 -0400

ABSTRACT: Pregnant women traditionally have been assigned priority in the allocation of prevention and treatment resources during outbreaks of influenza because of their increased risk of morbidity and mortality. The Committee on Ethics of the American College of Obstetricians and Gynecologists explores ethical justifications for assigning priority for prevention and treatment resources to pregnant women during an influenza pandemic, makes recommendations to incorporate ethical issues in pandemic influenza planning concerning pregnant women, and calls for pandemic preparedness efforts to include clinical research specifically designed to address safety and efficacy of treatment interventions or prevention strategies used by pregnant women.

Müllerian Agenesis Diagnosis Management and Treatment

resources@acog.org — Mon, 22 Apr 2013 16:24:21 -0400

ABSTRACT: Müllerian agenesis occurs in 1 out of every 4,000–10,000 females. The most common presentation of müllerian agenesis is congenital absence of the vagina, uterus, or both, which also is referred to as müllerian aplasia, Mayer–Rokitansky–Küster–Hauser syndrome, or vaginal agenesis. Satisfactory vaginal creation usually can be managed nonsurgically with successive vaginal dilation; however, there are a variety of surgical options for creation of a neovagina. Regardless of the treatment option selected, patients should be thoroughly counseled and prepared psychologically before the initiation of any treatment. Evaluation for associated congenital renal anomalies or other anomalies is also important. Although exact gynecologic screening recommendations are evolving, all women with a neovagina should undergo routine gynecologic care; however, vaginal cytologic screening is not indicated.

May-June 2013

resources@acog.org — Mon, 22 Apr 2013 16:21:13 -0400

EDITORIAL: Educational Needs of Young Physicians in Early Practice

Adult Manifestations of Childhood Sexual Abuse

resources@acog.org — Mon, 22 Apr 2013 16:10:54 -0400

ABSTRACT: Long-term effects of childhood sexual abuse are varied, complex, and often devastating. Many obstetrician-gynecologists knowingly or unknowingly provide care to abuse survivors and should screen all women for a history of such abuse. Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse. Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, nonspecific vaginitis, and gastrointestinal disorders are common diagnoses among survivors. Survivors may be less likely to have regular Pap tests and may seek little or no prenatal care. Obstetrician-gynecologists can offer support to abuse survivors by giving them empowering messages, counseling referrals, and empathic care during sensitive examinations.

At-Risk Drinking and Alcohol Dependence - Obstetric and Gynecologic Implications

resources@acog.org — Mon, 22 Apr 2013 16:10:38 -0400

ABSTRACT: Compared with men, at-risk alcohol use by women has a disproportionate effect on their health and lives, including reproductive function and pregnancy outcomes. Obstetrician–gynecologists have a key role in screening and providing brief intervention, patient education, and treatment referral for their patients who drink alcohol at risk levels. For women who are not physically addicted to alcohol, tools such as brief intervention and motivational interviewing can be used effectively by the clinician and incorporated into an office visit. For pregnant women and those at risk of pregnancy, it is important for the obstetrician–gynecologist to give compelling and clear advice to avoid alcohol use, provide assistance for achieving abstinence, or provide effective contraception to women who require help. Health care providers should advise women that low-level consumption of alcohol in early pregnancy is not an indication for pregnancy termination.

Cultural Sensitivity and Awareness in the Delivery of Health Care

resources@acog.org — Mon, 22 Apr 2013 16:09:47 -0400

ABSTRACT: Communication with patients can be improved and patient care enhanced if health care providers can bridge the divide between the culture of medicine and the beliefs and practices that make up patients' value systems. These may be based on ethnic heritage, nationality of family origin, age, religion, sexual orientation, disability, or socioeconomic status. Every health care encounter provides an opportunity to have a positive effect on patient health. Health care providers can maximize this potential by learning more about patients' cultures.

Partnering With Patients to Improve Safety

resources@acog.org — Mon, 22 Apr 2013 16:08:47 -0400

ABSTRACT: Actively involving patients in the planning of health services is recommended as a means of improving the quality of care. This can increase patient engagement and reduce risk resulting in improved outcomes, satisfaction, and treatment adherence.

Prevention of Early-Onset Group B Streptococcal Disease in Newborns

resources@acog.org — Mon, 22 Apr 2013 16:08:10 -0400

ABSTRACT: In 2010, the Centers for Disease Control and Prevention revised its guidelines for the prevention of perinatal group B streptococcal disease. Although universal screening at 35–37 weeks of gestation and intrapartum antibiotic prophylaxis continue to be the basis of the prevention strategy, these new guidelines contain important changes for clinical practice. The Committee on Obstetric Practice endorses the new Centers for Disease Control and Prevention recommendations, and recognizes that even complete implementation of this complex strategy will not eliminate all cases of early-onset group B streptococcal disease.

Methamphetamine Abuse in Women of Reproductive Age

resources@acog.org — Mon, 22 Apr 2013 16:06:56 -0400

ABSTRACT: Methamphetamine abuse has continued to increase in the United States since the late 1980s with its use spreading from the West Coast to areas across the country. Methamphetamine use in pregnancy endangers the health of the woman and increases the risk of low birth weight and small for gestational age babies and such use may increase the risk of neurodevelopmental problems in children. All pregnant women should be asked about their drug and alcohol use. Urine toxicology screening may be useful in detecting methamphetamine and other substance abuse during pregnancy, but this screening should only be done with maternal consent after counseling regarding the potential ramifications of a positive test result. Women reporting continuing use of methamphetamine in pregnancy should be referred for treatment and followed up with serial ultrasound examinations to assess fetal growth.

Planned Home Birth

resources@acog.org — Mon, 22 Apr 2013 16:06:20 -0400

ABSTRACT: Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth. Importantly, women should be informed that the appropriate selection of candidates for home birth; the availability of a certified nurse–midwife, certified midwife, or physician practicing within an integrated and regulated health system; ready access to consultation; and assurance of safe and timely transport to nearby hospitals are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes.

Antenatal Corticosteroid Therapy for Fetal Maturation

resources@acog.org — Mon, 22 Apr 2013 16:05:38 -0400

ABSTRACT: A single course of corticosteroids is recommended for pregnant women between 24 weeks and 34 weeks of gestation who are at risk of preterm delivery within 7 days. A single course of antenatal corticosteroids should be administered to women with premature rupture of membranes before 32 weeks of gestation to reduce the risks of respiratory distress syndrome, perinatal mortality, and other morbidities. The efficacy of corticosteroid use at 32–33 completed weeks of gestation for preterm premature rupture of membranes is unclear, but treatment may be beneficial, particularly if pulmonary immaturity is documented. Sparse data exist on the efficacy of corticosteroid use before fetal age of viability, and such use is not recommended. A single rescue course of antenatal corticosteroids may be considered if the antecedent treatment was given more than 2 weeks prior, the gestational age is less than 32 6/7 weeks, and the women are judged by the clinician to be likely to give birth within the next week. However, regularly scheduled repeat courses or multiple courses (more than two) are not recommended. Further research regarding the risks and benefits, optimal dose, and timing of a single rescue course of steroid treatment is needed.

Nonobstetric Surgery During Pregnancy

resources@acog.org — Mon, 22 Apr 2013 16:04:40 -0400

ABSTRACT: The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice acknowledges that the issue of nonobstetric surgery during pregnancy is an important concern for physicians who care for women. It is important for a physician to obtain an obstetric consultation before performing nonobstetric surgery and some invasive procedures (eg, cardiac catheterization or colonoscopy) because obstetricians are uniquely qualified to discuss aspects of maternal physiology and anatomy that may affect intraoperative maternal–fetal well-being. Ultimately, each case warrants a team approach (anesthesia and obstetric care providers, surgeons, pediatricians, and nurses) for optimal safety of the woman and the fetus.

April 2013

resources@acog.org — Wed, 17 Apr 2013 14:41:44 -0400

See how your ob-gyn colleagues are striving for a better work-life balance.

Reading the Medical Literature

Tue, 16 Apr 2013 15:43:40 -0400

Hysteroscopy

resources@acog.org — Fri, 12 Apr 2013 10:39:49 -0400

Hysteroscopy is a technique used to look inside the uterus. A hysteroscope is a thin, telescope-like device that is placed into the uterus through the vagina and cervix. It may help diagnose or treat a uterine problem.

Obesity and Pregnancy

resources@acog.org — Fri, 12 Apr 2013 09:49:49 -0400

Pregnancy is an exciting time of major change. From the very start, your growing baby changes your body and the way you live your daily life. The best way to approach pregnancy and childbirth is to be informed. As soon as you know you are pregnant, call your health care provider to schedule an appointment so you can start prenatal care right away. You will be giving your baby a healthy start in life.

Repeated Miscarriage

resources@acog.org — Thu, 11 Apr 2013 15:56:40 -0400

Most women who have a miscarriage go on to have healthy pregnancies. A small number of women (1%) will have repeated miscarriages. Repeated miscarriage or recurrent pregnancy loss is defined as having two or more miscarriages. After three miscarriages, a thorough physical exam and testing are recommended. You also may benefit from counseling and support. Even if no cause is found, successful pregnancy is likely for most couples who have had repeated pregnancy losses.

Elective Delivery Before 39 Weeks

resources@acog.org — Thu, 11 Apr 2013 15:54:59 -0400

A normal pregnancy lasts about 40 weeks. It was once thought that babies born a few weeks early—between 37 weeks and 39 weeks—were just as healthy as babies born after 39 weeks. Experts now know that babies grow throughout the entire 40 weeks of pregnancy. This is important if you are thinking about scheduling your baby’s birth for a nonmedical reason. Health care professionals recommend that unless there is a valid health reason or labor starts on its own, delivery should not occur before at least 39 weeks.

Endometrial Hyperplasia

resources@acog.org — Wed, 10 Apr 2013 16:56:54 -0400

Endometrial hyperplasia occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer of the uterus. Early diagnosis and treatment are important. For some women who are at increased risk of hyperplasia, medication can be taken to decrease their risk.

Planning Your Pregnancy

resources@acog.org — Wed, 10 Apr 2013 09:44:49 -0400

You have decided to have a baby. Congratulations! Welcome to the first part of a journey that will transform your life. By planning ahead and making needed changes before you become pregnant—during the preconception period—you are more likely to be prepared. A key part of planning a pregnancy is preconception care.

Von Willebrand Disease in Women

resources@acog.org — Tue, 09 Apr 2013 16:44:29 -0400

ABSTRACT: Approximately 3 million women in the United States have inherited bleeding disorders. The prevalence of bleeding disorders is particularly high among women with menorrhagia. Von Willebrand disease is the most common inherited bleeding disorder. Once a diagnosis is made, collaboration with a hematologist is helpful for long-term management. Women with von Willebrand disease may be at increased risk for gynecologic and obstetric complications. Many treatments are available for the control of menorrhagia in women with von Willebrand disease, but the first-line therapy remains combined hormonal contraception.

You and Your Sexuality -- Especially for Teens

resources@acog.org — Wed, 27 Mar 2013 16:22:05 -0400

The teen years are exciting. They also can be confusing. Your body is changing. You are dealing with new feelings. You may find yourself thinking about and exploring your sexuality. Forms of sexual expression can range from holding hands and hugging to touching, kissing, and having sexual intercourse or other forms of sex.

Vaginal Birth After Cesarean Delivery Deciding on a Trial of Labor

resources@acog.org — Wed, 27 Mar 2013 16:01:45 -0400

It was once thought that if a woman had one cesarean delivery, all other babies she had should be born in the same way. Today, it is known that many women can undergo a trial of labor after a cesarean delivery (called TOLAC). After a successful TOLAC, many women will be able to give birth through the vagina (called a vaginal birth after cesarean delivery, or VBAC).

Keeping Your Heart Healthy

resources@acog.org — Tue, 26 Mar 2013 17:03:40 -0400

Many women are not aware of their risk of heart disease. In the United States, it is the leading cause of death of women. Each year, more than 300,000 women die from heart disease. This compares to about 40,000 deaths from breast cancer.

Hysterosalpingography

resources@acog.org — Tue, 26 Mar 2013 11:38:02 -0400

Hysterosalpingography (HSG) is used to diagnose problems of the uterus and fallopian tubes. Most often it is used to see if a woman's tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape.

HIV and Pregnancy

resources@acog.org — Tue, 26 Mar 2013 11:04:02 -0400

If you are pregnant and are infected with human immunodeficiency virus (HIV), the virus can be passed to your baby. The good news is that there are steps you can take that can greatly reduce the chance of this happening. Treatment during pregnancy also can help you stay healthy.

Guidelines for Perinatal Care

Tue, 26 Mar 2013 10:21:53 -0400

http://www.acog.org/~/media/Guidelines%20for%20Perinatal%20Care/GuidelinesforPerinatalCare.pdf

Vaginal Birth After Previous Cesarean Delivery

resources@acog.org — Mon, 25 Mar 2013 09:43:44 -0400

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal—a vaginal birth after cesarean delivery (VBAC)†. In addition to fulfilling a patient's preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery. *The term trial of labor refers to a trial of labor in women who have had a previous cesarean delivery, regardless of the outcome. †The term vaginal birth after cesarean delivery is used to denote a vaginal delivery after a trial of labor.

Integrating Immunizations Into Practice

resources@acog.org — Thu, 21 Mar 2013 17:03:56 -0400

ABSTRACT: Given demonstrated vaccine efficacy, safety, and the large potential for prevention of many infectious diseases among adults, newborns, and pregnant women, obstetrician–gynecologists should embrace immunizations as an integral part of their women’s health care practice. To provide direct examples, evidence-based recommendations for three commonly administered immunizations by practicing obstetrician–gynecologists are discussed: 1) human papillomavirus vaccine, 2) influenza vaccine, and 3) tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine.

Nonmedically Indicated Early-Term Deliveries

resources@acog.org — Thu, 21 Mar 2013 16:17:49 -0400

ABSTRACT: For certain medical conditions, available data and expert opinion support optimal timing of delivery in the late-preterm or early-term period for improved neonatal and infant outcomes. However, for nonmedically indicated early-term deliveries such an improvement has not been demonstrated. Morbidity and mortality rates are greater among neonates and infants delivered during the early-term period compared with those delivered between 39 weeks and 40 weeks of gestation. Nevertheless, the rate of nonmedically indicated early-term deliveries continues to increase in the United States. Implementation of a policy to decrease the rate of nonmedically indicated deliveries before 39 weeks of gestation has been found to both decrease the number of these deliveries and improve neonatal outcomes; however, more research is necessary to further characterize pregnancies at risk for in utero morbidity or mortality. Also of concern is that at least one state Medicaid agency has stopped reimbursement for nonindicated deliveries before 39 weeks of gestation. Avoidance of nonindicated delivery before 39 weeks of gestation should not be accompanied by an increase in expectant management of patients with indications for delivery before 39 weeks of gestation. Management decisions, therefore, should balance the risks of pregnancy prolongation with the neonatal and infant risks associated with early-term delivery.

Medically Indicated Late-Preterm and Early-Term Deliveries

resources@acog.org — Thu, 21 Mar 2013 16:17:07 -0400

ABSTRACT: The neonatal risks of late preterm (34 0/7–36 6/7 weeks of gestation) and early-term (37 0/7–38 6/7 weeks of gestation) births are well established. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks of further continuation of pregnancy. Decisions regarding timing of delivery must be individualized. Amniocentesis for the determination of fetal lung maturity in well-dated pregnancies generally should not be used to guide the timing of delivery.

Cesarean Delivery on Maternal Request

resources@acog.org — Thu, 21 Mar 2013 16:16:08 -0400

ABSTRACT: Cesarean delivery on maternal request is defined as a primary prelabor cesarean delivery on maternal request in the absence of any maternal or fetal indications. Potential risks of cesarean delivery on maternal request include a longer maternal hospital stay, an increased risk of respiratory problems for the infant, and greater complications in subsequent pregnancies, including uterine rupture, placental implantation problems, and the need for hysterectomy. Potential short-term benefits of planned cesarean delivery compared with a planned vaginal delivery (including women who give birth vaginally and those who require cesarean delivery in labor) include a decreased risk of hemorrhage and transfusion, fewer surgical complications, and a decrease in urinary incontinence during the first year after delivery. Given the balance of risks and benefits, the Committee on Obstetric Practice believes that in the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended to patients. In cases in which cesarean delivery on maternal request is planned, delivery should not be performed before a gestational age of 39 weeks. Cesarean delivery on maternal request should not be motivated by the unavailability of effective pain management. Cesarean delivery on maternal request particularly is not recommended for women desiring several children, given that the risks of placenta previa, placenta accreta, and gravid hysterectomy increase with each cesarean delivery.

Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women

resources@acog.org — Thu, 21 Mar 2013 16:11:46 -0400

ABSTRACT: Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabilization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system. Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on the patient’s medical history and contraindications to therapies. Surgical management should be considered for patients who are not clinically stable, are not suitable for medical management, or have failed to respond appropriately to medical management. The choice of surgical management should be based on the patient’s underlying medical conditions, underlying pathology, and desire for future fertility. Once the acute bleeding episode has been controlled, transitioning the patient to long-term maintenance therapy is recommended.

Postmenopausal Estrogen Therapy: Route of Administration and Risk of Venous Thromboembolism

resources@acog.org — Thu, 21 Mar 2013 16:09:42 -0400

ABSTRACT: The development of menopausal symptoms and related disorders, which lead women to seek prescriptions for postmenopausal estrogen therapy and hormone therapy, is a common reason for a patient to visit her gynecologist, but these therapies are associated with an increased risk of venous thromboembolism. The relative risk seems to be even greater if the treated population has preexisting risk factors for venous thromboembolism, such as obesity, immobilization, and fracture. Recent studies suggest that orally administered estrogen may exert a prothrombotic effect, whereas transdermally administered estrogen has little or no effect in elevating prothrombotic substances and may have beneficial effects on proinflammatory markers. When prescribing estrogen therapy, the gynecologist should take into consideration the possible thrombosis-sparing properties of transdermal forms of estrogen therapy. As part of the shared decision-making process, the gynecologist should weigh the risks against the benefits when prescribing combination estrogen plus progestin hormone therapy or estrogen therapy and counsel the patient accordingly.

Genetic Disorders

resources@acog.org — Thu, 21 Mar 2013 15:39:48 -0400

Problems in the genes or chromosomes of a fetus are called genetic disorders. These disorders may be inherited (passed from parent to child) or they may occur without a family history.

Some genetic disorders are more likely if you have a certain ethnic background or if you have a family history of a disorder. Counseling can help predict your risk, and testing may find the disorder.

Fetal Heart Rate Monitoring During Labor

resources@acog.org — Thu, 21 Mar 2013 15:33:34 -0400

During labor and delivery, the condition of the baby is checked using fetal heart rate monitoring. Although it cannot prevent problems from occurring, fetal heart rate monitoring may be able to alert health care providers to possible problems and allow steps to be taken that may help your baby.

Domestic Violence

resources@acog.org — Tue, 19 Mar 2013 13:04:36 -0400

Domestic, or intimate partner, violence may be one of America’s most widespread health problems—and yet one of the least reported. It is of special concern to women because most abuse victims are female.

Domestic violence knows no economic, educational, racial, religious, or age barriers. Abuse happens in intimate relationships between couples from all walks of life. It is most common in couples who are male and female.

Diagnostic Tests for Birth Defects

resources@acog.org — Tue, 19 Mar 2013 12:46:49 -0400

Diagnostic tests can be done to find some birth defects before a baby is born. Diagnostic tests may be done after screening test results show that there may be a problem, or if other factors raise concern. Unlike screening tests, which can show only the possibility of a problem, prenatal diagnostic tests are able to detect certain birth defects in the fetus.

Car Safety for You and Your Baby

resources@acog.org — Tue, 19 Mar 2013 12:33:49 -0400

Car safety is important before and after your baby is born. When you are pregnant, the best way to keep yourself and your baby safe in a car is to use safety belts. After your baby is born, make sure your baby is strapped into a special safety seat and that you buckle up each time you ride in a car.

Preterm Labor and Preterm Birth

resources@acog.org — Fri, 15 Mar 2013 13:15:54 -0400

A normal pregnancy lasts about 40 weeks from the first day of the last menstrual period. When labor starts before 37 weeks of pregnancy, it is called preterm labor. About one half of all the preterm births in the United States are preceded by preterm labor.

Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care

resources@acog.org — Thu, 14 Mar 2013 09:58:27 -0400

ABSTRACT: Numerous occurrences in the past decade have brought the issue of disaster preparedness, and specifically hospital preparedness, to the national forefront. Much of the work in this area has focused on large hospital system preparedness for various disaster scenarios. Many unique features of the obstetric population warrant additional consideration in order to optimize the care received by expectant mothers and their fetuses or newborns in the face of future natural or biologic disasters.

September-October 2012

resources@acog.org — Wed, 13 Mar 2013 14:20:10 -0400

EDITORIAL: Evolution of Our Specialty

September-October 2011

resources@acog.org — Wed, 13 Mar 2013 14:19:13 -0400

EDITORIAL: The Importance of Junior Fellowship

September-October 2010

resources@acog.org — Wed, 13 Mar 2013 14:18:40 -0400

EDITORIAL: More on College Versus Congress

September-October 2009

resources@acog.org — Wed, 13 Mar 2013 14:18:13 -0400

EDITORIAL: The College and the Congress

September-October 2008

resources@acog.org — Wed, 13 Mar 2013 14:17:10 -0400

Book Review: Rx for Happiness: An OB/GYN's Story

September-October 2007

resources@acog.org — Wed, 13 Mar 2013 14:16:40 -0400

EDITORIAL: ACOG Annual Clinical Meetings: San Diego '07 and New Orleans '08

September-October 2006

resources@acog.org — Wed, 13 Mar 2013 14:16:01 -0400

EDITORIAL: Jet Lag Management

September-October 2005

resources@acog.org — Wed, 13 Mar 2013 14:15:30 -0400

Internal Revenue Code Section 4958

September-October 2004

resources@acog.org — Wed, 13 Mar 2013 14:14:39 -0400

Editorial: Cardiovascular Disease Prevention in Women

November-December 2012

resources@acog.org — Wed, 13 Mar 2013 14:13:46 -0400

Overview of the 2012 American Congress of Obstetricians and Gynecologists’ Survey on Professional Liability

November-December 2011

resources@acog.org — Wed, 13 Mar 2013 14:13:03 -0400

Evolution of the American College of Obstetricians and Gynecologists' Physician Guidance.

November-December 2010 Supplement

resources@acog.org — Wed, 13 Mar 2013 14:12:24 -0400

Health Care Reform and Your Practice

November-December 2010

resources@acog.org — Wed, 13 Mar 2013 14:11:47 -0400

Editorial; The American Congress of Obstetricians and Gynecologists and Health Care Reform

November-December 2009

resources@acog.org — Wed, 13 Mar 2013 14:10:57 -0400

Overview of the 2009 ACOG Survey on Professional Liability

November-December 2008

resources@acog.org — Wed, 13 Mar 2013 14:09:39 -0400

EDITORIAL: American Medical Association

November-December 2007

resources@acog.org — Wed, 13 Mar 2013 14:09:10 -0400

EDITORIAL: A Call to Join the American Medical Association

November-December 2006

resources@acog.org — Wed, 13 Mar 2013 14:08:27 -0400

BOOK REVIEW: Where Have All the Mothers Gone

November-December 2005

resources@acog.org — Wed, 13 Mar 2013 14:07:50 -0400

BOOK REVIEW: Events, Stress, and Litigation

November-December 2004

resources@acog.org — Wed, 13 Mar 2013 14:06:48 -0400

Editorial: Overview of the 2003 ACOG Survey of Professional Liability

May-June 2012

resources@acog.org — Wed, 13 Mar 2013 14:06:21 -0400

EDITORIAL: Why 39 Weeks?

May-June 2011

resources@acog.org — Wed, 13 Mar 2013 14:05:43 -0400

EDITORIAL: Clinical Review Over the Years

May-June 2010

resources@acog.org — Wed, 13 Mar 2013 14:04:43 -0400

EDITORIAL: An Introduction to the Medical Home

May-June 2009

resources@acog.org — Wed, 13 Mar 2013 14:04:05 -0400

EDITORIAL: The American Congress of Obstetricians and Gynecologists: A New Partner

May-June 2008

resources@acog.org — Wed, 13 Mar 2013 14:03:31 -0400

EDITORIAL: Preventing Fetal Alcohol Syndrome

May-June 2007

resources@acog.org — Wed, 13 Mar 2013 14:03:08 -0400

BOOK REVIEW: Physician Specialty Data: A Chart Book*

May-June 2006

resources@acog.org — Wed, 13 Mar 2013 14:02:32 -0400

EDITORIAL: Surviving Burnout

May-June 2005

resources@acog.org — Wed, 13 Mar 2013 14:01:53 -0400

BOOK REVIEW: War and Love

May-June 2004

resources@acog.org — Wed, 13 Mar 2013 14:01:11 -0400

Editorial: Fish in Troubled Waters

March-April 2013

resources@acog.org — Wed, 13 Mar 2013 14:00:09 -0400

EDITORIAL: Principles of Professionalism

March-April 2012

resources@acog.org — Wed, 13 Mar 2013 13:59:38 -0400

EDITORIAL: Evolving Educational Opportunities

March-April 2011

resources@acog.org — Wed, 13 Mar 2013 13:59:04 -0400

EDITORIAL: The Committee Selection Process

March-April 2010

resources@acog.org — Wed, 13 Mar 2013 13:58:22 -0400

EDITORIAL: New Look for the Clinical Review

March-April 2009

resources@acog.org — Wed, 13 Mar 2013 13:57:22 -0400

EDITORIAL: Ambulatory Women's Health Care

March-April 2008

resources@acog.org — Wed, 13 Mar 2013 13:56:54 -0400

EDITORIAL: The Obstetrician-Gynecologists as Vaccinator

March-April 2007

resources@acog.org — Wed, 13 Mar 2013 13:56:22 -0400

EDITORIAL: Overview of the 2006 ACOG Survey on Professional Liability

March-April 2006

resources@acog.org — Wed, 13 Mar 2013 13:55:31 -0400

EDITORIAL: The Reproductive Scientist Development Program

March-April 2005

resources@acog.org — Wed, 13 Mar 2013 13:54:44 -0400

Elective Prophylactic Cesarean Delivery

March-April 2004

resources@acog.org — Wed, 13 Mar 2013 13:53:52 -0400

Book Review: What Do I Say? Communicating Intended or Unanticipated Outcomes in Obstetrics

July-August 2012

resources@acog.org — Wed, 13 Mar 2013 13:53:12 -0400

Annual Board Certification Examination

July-August 2011 Supplement

resources@acog.org — Wed, 13 Mar 2013 13:52:22 -0400

National Fetal and Infant Mortality Review Program: From Presidential Initiative to Successful Long-Term Collaboration

July-August 2011

resources@acog.org — Wed, 13 Mar 2013 13:51:51 -0400

EDITORIAL: Dr. Ralph Hale Retires

July-August 2010

resources@acog.org — Wed, 13 Mar 2013 13:51:23 -0400

Annual Board Certification Examination*

July-August 2009

resources@acog.org — Wed, 13 Mar 2013 13:49:54 -0400

Annual Board Certification Exam

July-August 2008

resources@acog.org — Wed, 13 Mar 2013 13:49:24 -0400

EDITORIAL: How a Clinical Decision Support System Can Enhance an Electronic Medical Record

July-August 2007

resources@acog.org — Wed, 13 Mar 2013 13:48:53 -0400

EDITORIAL: Immunizations in Obstetric-Gynecologic Practice

July-August 2006

resources@acog.org — Wed, 13 Mar 2013 13:48:10 -0400

EDITORIAL: Before Katrina, After Katrina

July-August 2005

resources@acog.org — Wed, 13 Mar 2013 13:47:31 -0400

BOOK REVIEW: Reproductive Health and Human Rights

July-August 2004

resources@acog.org — Wed, 13 Mar 2013 13:46:32 -0400

Editorial: A Definition of Primary Care

January-February 2013

resources@acog.org — Wed, 13 Mar 2013 13:39:02 -0400

Editorial: Why You Should be in New Orleans for the Annual Clinical Meeting

January-February 2012

resources@acog.org — Wed, 13 Mar 2013 13:38:29 -0400

Editorial: Re-entry Into Practice

January-February 2011

resources@acog.org — Wed, 13 Mar 2013 13:37:08 -0400

EDITORIAL: Presidential Initiatives for 2010-2011

January-February 2010

resources@acog.org — Wed, 13 Mar 2013 13:35:46 -0400

Out-of-Hospital-Birth Registry

January-February 2009

resources@acog.org — Wed, 13 Mar 2013 13:35:02 -0400

EDITORIAL: What's Missing?

January-February 2008

resources@acog.org — Wed, 13 Mar 2013 13:23:53 -0400

Annual Board Certification Examination

January-February 2004

resources@acog.org — Wed, 13 Mar 2013 13:22:07 -0400

ABOG Maintenance of Certification Examination

January-February 2005

resources@acog.org — Wed, 13 Mar 2013 13:21:57 -0400

ABOG Maintenance of Certification Exam

January-February 2006

resources@acog.org — Wed, 13 Mar 2013 13:21:46 -0400

ABOG Maintenance of Certification Examination

January-February 2007

resources@acog.org — Wed, 13 Mar 2013 13:21:21 -0400

Annual Board Certification Examination

A Father's Guide to Pregnancy

resources@acog.org — Thu, 07 Mar 2013 09:59:01 -0500

If you are like most expectant fathers, you are both excited and anxious about this big step in the lives of you and your partner. You can help your partner by understanding the changes she is going through and by being a prepared and supportive father-to-be.

Urinary Tract Infections

resources@acog.org — Fri, 01 Mar 2013 11:48:04 -0500

Many women have a urinary tract infection (UTI) at some point during their lives. Some women will have repeat infections and may have them often. Most UTIs are not serious. They are easy to treat with antibiotics, and symptoms can be relieved quickly.

February 2013

resources@acog.org — Fri, 22 Feb 2013 10:20:52 -0500

Get a preview of the Annual Clinical Meeting with the February 2013 issue of the ACOG Today newsletter.

Screening for Depression During and After Pregnancy

resources@acog.org — Thu, 21 Feb 2013 09:32:38 -0500

Abstract: Depression is very common during pregnancy and the postpartum period. At this time, there is insufficient evidence to support a firm recommendation for universal antepartum or postpartum screening. There are also insufficient data to recommend how often screening should be done. There are multiple depression screening tools available for use.

Umbilical Cord Blood Banking

resources@acog.org — Thu, 21 Feb 2013 09:32:14 -0500

ABSTRACT: Two types of banks have emerged for the collection and storage of umbilical cord blood—public banks and private banks. Public banks promote allogenic (related or unrelated) donation, analogous to the current collection of whole blood units in the United States. Private banks were initially developed to store stem cells from umbilical cord blood for autologous use (taken from an individual for subsequent use by the same individual) by a child if the child develops disease later in life. If a patient requests information on umbilical cord blood banking, balanced and accurate information regarding the advantages and disadvantages of public versus private banking should be provided. The remote chance of an autologous unit of umbilical cord blood being used for a child or a family member (approximately 1 in 2,700 individuals) should be disclosed. The collection should not alter routine practice for the timing of umbilical cord clamping. Physicians or other professionals who recruit pregnant women and their families for for-profit umbilical cord blood banking should disclose any financial interests or other potential conflicts of interest.

Subclinical Hypothyroidism in Pregnancy

resources@acog.org — Thu, 21 Feb 2013 09:31:35 -0500

ABSTRACT: Subclinical hypothyroidism is diagnosed in asymptomatic women when the thyroid-stimulating hormone level is elevated and the free thyroxine level is within the reference range. Thyroid hormones, specifically thyroxine, are essential for normal fetal brain development. However, data indicating fetal benefit from thyroxine supplementation in pregnant women with subclinical hypothyroidism currently are not available. Based on current literature, thyroid testing in pregnancy should be performed on symptomatic women and those with a personal history of thyroid disease or other medical conditions associated with thyroid disease (eg, diabetes mellitus). Without evidence that identification and treatment of pregnant women with subclinical hypothyroidism improves maternal or infant outcomes, routine screening for subclinical hypothyroidism currently is not recommended.

Nalbuphine Hydrochloride Use for Intrapartum Analgesia

resources@acog.org — Thu, 21 Feb 2013 09:27:41 -0500

ABSTRACT: Safety concerns have been raised regarding the use of nalbuphine hydrochloride during labor. The American College of Obstetricians and Gynecologists finds data are insufficient to recommend any changes in nalbuphine hydrochloride administration at this time.

Umbilical Cord Blood Gas and Acid-Base Analysis

resources@acog.org — Thu, 21 Feb 2013 09:25:37 -0500

ABSTRACT: Umbilical cord blood gas and acid-base assessment are the most objective determinations of the fetal metabolic condition at the moment of birth. Moderate and severe newborn encephalopathy, respiratory complications, and composite complication scores increase with an umbilical arterial base deficit of 12–16 mmol/L. Moderate or severe newborn complications occur in 10% of neonates who have this level of acidemia and the rate increases to 40% in neonates who have an umbilical arterial base deficit greater than 16 mmol/L at birth. Immediately after the delivery of the neonate, a segment of umbilical cord should be double-clamped, divided, and placed on the delivery table. Physicians should attempt to obtain venous and arterial cord blood samples in circumstances of cesarean delivery for fetal compromise, low 5-minute Apgar score, severe growth restriction, abnormal fetal heart rate tracing, maternal thyroid disease, intrapartum fever, or multifetal gestation.

Amnioinfusion Does Not Prevent Meconium Aspiration Syndrome

resources@acog.org — Thu, 21 Feb 2013 09:22:57 -0500

ABSTRACT: Amnioinfusion has been advocated as a technique to reduce the incidence of meconium aspiration and to improve neonatal outcome. However, a large proportion of women with meconium-stained amniotic fluid have infants who have taken in meconium within the trachea or bronchioles before meconium passage has been noted and before amnioinfusion can be performed by the obstetrician; meconium passage may predate labor. Based on current literature, routine prophylactic amnioinfusion for the dilution of meconium-stained amniotic fluid is not recommended. Prophylactic use of amnioinfusion for meconium-stained amniotic fluid should be done only in the setting of additional clinical trials. However, amnioinfusion remains a reasonable approach in the treatment of repetitive variable decelerations, regardless of amniotic fluid meconium status.

Mode of Term Singleton Breech Delivery

resources@acog.org — Thu, 21 Feb 2013 09:21:02 -0500

ABSTRACT: In light of recent studies that further clarify the long-term risks of vaginal breech delivery, the American College of Obstetricians and Gynecologists recommends that the decision regarding mode of delivery should depend on the experience of the health care provider. Cesarean delivery will be the preferred mode for most physicians because of the diminishing expertise in vaginal breech delivery. Planned vaginal delivery of a term singleton breech fetus may be reasonable under hospital-specific protocol guidelines for both eligibility and labor management. Before a vaginal breech delivery is planned, women should be informed that the risk of perinatal or neonatal mortality or short-term serious neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed consent should be documented.

Alcohol Use

resources@acog.org — Wed, 20 Feb 2013 12:30:11 -0500

What should you know about alcohol use? Alcohol is the drug most often used and abused by teenagers; Alcohol use includes beer, wine, wine coolers, hard liquor, and mixed drinks; Alcohol is a chemical that can be harmful to many body organs; Binge drinking for women is having more then three drinks per occasion; Drinking games, competitions, and bets can be life
threatening.

Acquaintance and Date Rape

resources@acog.org — Wed, 20 Feb 2013 12:27:28 -0500

What is rape or sexual assault? Any genital, oral, or anal penetration without consent (permission) is rape. Rape is a crime. Nothing a person does justifies being raped. Inappropriate touching also is not acceptable.

ACOG Adolescent Visit Record and ACOG Adolescent Visit and Parent Questionnaires

resources@acog.org — Wed, 20 Feb 2013 12:25:30 -0500

Physicians should develop office procedures that safeguard their adolescent patients’ rights. These procedures will vary by practice, staff capabilities, and facilities. An initial and annual
office visit process is described that works well with the ACOG Adolescent Visit Questionnaire, ACOG Parent Questionnaire, and ACOG Adolescent Visit Record, all of which can be adapted for an electronic medical record. These steps can be used for preventive visits in which the adolescent patient is accompanied by her parent or guardian but also could be used for problem visits.

Skin Cancer Prevention

resources@acog.org — Wed, 20 Feb 2013 12:19:50 -0500

What is skin cancer?
Your skin is made of cells that are constantly changing. Normal healthy cells eventually grow old and are replaced by new healthy cells. Cancer develops when
new cells form that are not needed and old or damaged cells do not die like they are supposed to. Eventually a mass or build up of these abnormal cells forms a tumor. Some tumors that form are benign (noncancerous), others are malignant (cancerous).

Acne

resources@acog.org — Wed, 20 Feb 2013 12:16:38 -0500

What is acne? Acne occurs when the pores of the skin become clogged with oil; Bacteria become trapped in the pore and irritate the skin and hair follicle; The irritation around the plugged pore and hair follicle forms a red bump called acne; A black plug, or blackhead, is formed when the dead
skin comes to the surface.

You and Your Baby

resources@acog.org — Fri, 15 Feb 2013 12:35:59 -0500

Treating Infertility

resources@acog.org — Tue, 05 Feb 2013 09:57:58 -0500

About 15% of couples in the United States are infertile. Infertility is defined as not having become pregnant after 1 year of having regular sexual intercourse without the use of birth control. The first step in treating infertility is to have an infertility evaluation. Treatment is available for many causes of infertility. Even if no cause is found, successful treatment to achieve pregnancy may still be possible.

Abnormal Uterine Bleeding

resources@acog.org — Thu, 31 Jan 2013 14:07:48 -0500

Abnormal uterine bleeding is one of the most common reasons women see their health care providers. It can occur at any age and has many causes. Finding the cause is the first step in treatment.

Having Twins

resources@acog.org — Tue, 29 Jan 2013 16:28:20 -0500

Today, more twins are being born than ever before. In 1980, twins were born only once in about every 55 births. Now, twins are born once in about every 31 births. This increase is mostly because of fertility treatments. A healthy twin pregnancy can be similar to a pregnancy with one baby. However, twin pregnancies can pose risks to the mother and babies. Special care may be needed during pregnancy. Parents may need extra help once the babies are born.

Hysterectomy

resources@acog.org — Tue, 29 Jan 2013 15:26:55 -0500

Hysterectomy is a way of treating problems that affect the uterus. Many conditions can be cured with hysterectomy. Because it is major surgery, you may want to explore other treatment options first. For conditions that have not responded to other treatments, a hysterectomy may be the best choice. You should be fully informed of all options before you decide.

Birth Control

resources@acog.org — Tue, 29 Jan 2013 14:04:33 -0500

Birth control is defined as any method or practice that prevents pregnancy. Today, there are many birth control methods to choose from. Some types of birth control help protect against sexually transmitted diseases (STDs). Some types have other health benefits in addition to birth control, such as making menstrual periods more regular, treating acne, and reducing the risk of some types of cancer. With all of the choices available, it is likely that you can find a method that fits your needs and lifestyle.

Laparoscopy

resources@acog.org — Mon, 28 Jan 2013 13:36:21 -0500

Laparoscopy is a type of surgery. It is used to detect and treat many health problems. Over the past 20 years, laparoscopy has become fairly common. It often can be performed as an out-patient procedure. Most patients recover from laparoscopic surgery within days.

Postpartum Sterilization

resources@acog.org — Fri, 25 Jan 2013 16:39:34 -0500

Postpartum sterilization is sterilization performed after the birth of a baby. Sterilization is a permanent method of birth control. It is a very effective way to prevent pregnancy and is the most popular form of birth control worldwide.

Sterilization by Laparoscopy

resources@acog.org — Fri, 25 Jan 2013 15:40:37 -0500

Sterilization is a permanent method of birth control. It is the most popular form of birth control worldwide. In the United States, a common way sterilization is performed in women is with laparoscopy. Laparoscopy is a way of doing surgery. It usually results in a fast recovery and few complications.

PROLOG eModules

Thu, 24 Jan 2013 15:09:57 -0500

Reproductive and Sexual Coercion

resources@acog.org — Thu, 24 Jan 2013 10:42:53 -0500

ABSTRACT: Reproductive and sexual coercion involves behavior intended to maintain power and control in a relationship related to reproductive health by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent. This behavior includes explicit attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex, and interfere with contraceptive methods. Obstetrician–gynecologists are in a unique position to address reproductive and sexual coercion and provide screening and clinical interventions to improve health outcomes. Because of the known link between reproductive health and violence, health care providers should screen women and adolescent girls for intimate partner violence and reproductive and sexual coercion at periodic intervals such as annual examinations, new patient visits, and during obstetric care (at the first prenatal visit, at least once per trimester, and at the postpartum checkup). Interventions include education on the effect of reproductive and sexual coercion and intimate partner violence on patients’ health and choices, counseling on harm-reduction strategies, and prevention of unintended pregnancies by offering long-acting methods of contraception that are less detectable to partners.

Multifetal Pregnancy Reduction

resources@acog.org — Wed, 23 Jan 2013 16:40:20 -0500

ABSTRACT: Fertility treatments have contributed significantly to the increase in multifetal pregnancies. The first approach to the problem of multifetal pregnancies should be prevention, and strategies to limit multifetal pregnancies, especially high-order multifetal pregnancies, should be practiced by all physicians who treat women for infertility. Incorporating the ethical frameworks presented in this Committee Opinion will help physicians counsel and guide patients when making decisions regarding multifetal pregnancy reduction. In cases of high-order multifetal pregnancies, counseling should include the availability of multifetal pregnancy reduction. Fellows should be knowledgeable about the medical risks of multifetal pregnancy, the possible medical benefits of multifetal pregnancy reduction, and the complex ethical issues inherent in decisions regarding the use of multifetal pregnancy reduction. Physicians should not be required to act in ways that conflict with their value systems but should be prepared to react in a professional and ethical manner to patient requests for both information and intervention.

Informed Consent

resources@acog.org — Wed, 23 Jan 2013 16:26:08 -0500

ABSTRACT: Obtaining informed consent for medical treatment, for participation in medical research, and for participation in teaching exercises involving students and residents is an ethical requirement that is partially reflected in legal doctrines and requirements. As an ethical doctrine, informed consent is a process of communication whereby a patient is enabled to make an informed and voluntary decision about accepting or declining medical care. In this Committee Opinion, the American College of Obstetricians and Gynecologists' Committee on Ethics describes the history, ethical basis, and purpose of informed consent and identifies special ethical questions pertinent to the practice of obstetrics and gynecology. Two major elements in the ethical concept of informed consent, comprehension (or understanding) and free consent, are reviewed. Limits to informed consent are addressed.

November 2012

resources@acog.org — Wed, 23 Jan 2013 12:42:19 -0500

The phrase "social media" gets thrown around a lot these days. The new lingo that comes with it—and the myriad of platforms—can be intimidating and confusing. But social media can be so much more than teenagers tweeting or families sharing photos of grandchildren. For physicians, social media can be an effective tool to disseminate critical health messages to your patients and the general public.

Antiphospholipid Syndrome

resources@acog.org — Fri, 18 Jan 2013 16:14:01 -0500

Antiphospholipid syndrome (APS) is an autoimmune disorder defined by the presence of characteristic clinical features and specified levels of circulating antiphospholipid antibodies (Box 1 and Box 2). Diagnosis requires that at least one clinical and one laboratory criterion are met. Because approximately 70% of individuals with APS are female (1), it is reasonably prevalent among women of reproductive age. Antiphospholipid antibodies are a diverse group of antibodies with specificity for binding to negatively charged phospholipids on cell surfaces. Despite the prevalence and clinical significance of APS, there is controversy about the indications for and types of antiphospholipid tests that should be performed in order to diagnose the condition. Much of the debate results from a lack of well-designed and controlled studies on the diagnosis and management of APS. The purpose of this document is to evaluate the data for diagnosis and treatment of APS.

Screening for Cervical Cancer

resources@acog.org — Fri, 18 Jan 2013 16:13:08 -0500

The incidence of cervical cancer in the United States has decreased more than 50% in the past 30 years because of widespread screening with cervical cytology. In 1975, the rate was 14.8 per 100,000 women. By 2008, it had been reduced to 6.6 per 100,000 women. Mortality from the disease has undergone a similar decrease from 5.55 per 100,000 women in 1975 to 2.38 per 100,000 women in 2008 (1). The American Cancer Society (ACS) estimates that there will be 12,170 new cases of cervical cancer in the United States in 2012, with 4,220 deaths from the disease (2). Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated 530,000 new cases of the disease and 275,000 resultant deaths each year (3, 4). When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed (5, 6).

New technologies for cervical cancer screening continue to evolve as do recommendations for managing the results. In addition, there are different risk–benefit considerations for women at different ages, as reflected in age-specific screening recommendations. The ACS, the American Society for Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical Pathology (ASCP) have recently updated their joint guidelines for cervical cancer screening (7), and an update to the U.S. Preventive Services Task Force recommendations also has been issued (8). The purpose of this document is to provide a review of the best available evidence regarding screening for cervical cancer.

Prediction and Prevention of Preterm Birth

resources@acog.org — Fri, 18 Jan 2013 16:12:00 -0500

Preterm birth is the leading cause of neonatal mortality in the United States, and preterm labor precedes approximately 50% of preterm births (1, 2). Neonatal intensive care has improved the survival rate for neonates at the cusp of viability, but it also has increased the proportion of survivors with disabilities (3). The incidence of multiple births also has increased along with the associated risk of preterm delivery (4). The purpose of this document is to describe the various methods proposed for identifying and treating asymptomatic women at increased risk of preterm birth and the evidence for their roles in clinical practice.

Osteoporosis

resources@acog.org — Fri, 18 Jan 2013 16:10:56 -0500

Osteoporosis has a fivefold greater prevalence in women than in men. In the United States, although women only have twice the fracture rate of men, they sustain 80% of hip fractures because older women far outnumber older men. In 2005, the cost for direct care of the estimated 2 million osteoporosis-related fractures was projected to be $17 billion, with hip fractures accounting for approximately 72% of the cost (1). Morbidity and loss of function can occur with all fractures and consequently present a significant burden to the patient, the family, and society. Morbidity and mortality are especially high with hip fractures. Of women older than 80 years who have had a hip fracture, only 56% could walk independently after 1 year (2). Approximately 3–6% of women die of complications while hospitalized for hip fracture, an outcome often correlated with comorbidity and age (2, 3). Many aspects of gynecology and obstetrics can affect bone health. Obstetrician–gynecologists have the opportunity to play a key role in the prevention of osteoporosis and osteoporotic fractures. The purpose of this practice bulletin is to review the diagnosis, evaluation, and treatment of osteoporosis.

Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women

resources@acog.org — Fri, 18 Jan 2013 16:10:20 -0500

Menstrual flow outside of normal volume, duration, regularity, or frequency is considered abnormal uterine bleeding (AUB). One third of outpatient visits to the gynecologist are for AUB, and it accounts for more than 70% of all gynecologic consults in the perimenopausal and postmenopausal years (1). Many new diagnostic modalities are available to assist the clinician in evaluating the woman with alterations in her normal menstrual patterns. The purpose of this document is to provide evidence-based management guidelines for the evaluation of the reproductive-aged patient with AUB. A secondary purpose is to introduce a new classification system for AUB. This document does not address pregnancy-related bleeding or postmenopausal bleeding.

Management of Preterm Labor

resources@acog.org — Fri, 18 Jan 2013 16:09:29 -0500

Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization (1–4). In the United States, approximately 12% of all live births occur before term, and preterm labor preceded approximately 50% of these preterm births (5, 6). Although the causes of preterm labor are not well understood, the burden of preterm births is clear—preterm births account for approximately 70% of neonatal deaths and 36% of infant deaths as well as 25–50% of cases of long-term neurologic impairment in children (7–9). A 2006 report from the Institute of Medicine estimated the annual cost of preterm birth in the United States to be $26.2 billion or more than $51,000 per premature infant (10). However, identifying women who will give birth preterm is an inexact process. The purpose of this document is to present the various methods proposed to manage preterm labor and to review the evidence for the roles of these methods in clinical practice. Identification and management of risk factors for preterm labor are not addressed in this document.

Management of Gynecologic Issues in Women With Breast Cancer

resources@acog.org — Fri, 18 Jan 2013 16:08:54 -0500

Breast cancer is the most common type of invasive cancer in American women, whose lifetime risk of the disease is one in eight. In 2009, there were an estimated 192,370 new cases of invasive breast cancer in the United States (1). Although rates have decreased slightly in the past few years, there are 2 million breast cancer survivors living in the United States. Improvements in prevention and screening and more effective treatment are continually occurring, and changes are relatively quickly translated into clinical practice. Breast cancer treatment is becoming more individualized and depends on both the extent of disease and individual tumor features. Treatments involve surgery, radiation therapy, chemotherapy, and hormonal therapies.

All types of breast cancer treatment have potential deleterious effects on women as well as how they view themselves. Therefore, it is important for women’s health care providers to have an understanding of breast cancer treatments and their potential gynecologic side effects. The purpose of this document is to review the effect of breast cancer treatment on common women’s health issues such as fertility, contraceptive management, menopause, sexual function, and osteoporosis, and to provide a rationale for follow-up and treatment of these gynecologic issues.

Chronic Hypertension in Pregnancy

resources@acog.org — Fri, 18 Jan 2013 16:06:38 -0500

Chronic hypertension is present in up to 5% of pregnant women; rates vary according to the population studied and the criteria used to establish the diagnosis (1–3). This complication may result in significant maternal, fetal, and neonatal morbidity and mortality. There has been considerable confusion over the terminology and criteria used to diagnose chronic hypertension as well as the potential benefit and harm of treatment with antihypertensive drugs during pregnancy. The purpose of this document is to review the effects of chronic hypertension on pregnancy, to clarify the terminology and criteria used to define and diagnose it during pregnancy, and to review the available evidence for management options.

Health Care for Urban American Indian and Alaska Native Women

resources@acog.org — Fri, 18 Jan 2013 15:50:24 -0500

ABSTRACT: Sixty percent of American Indian and Alaska Native women live in metropolitan areas. Most are not eligible for health care provided by the federal Indian Health Service (IHS). The IHS partly funds 34 Urban Indian Health Organizations, which vary in size and services. Some are small informational and referral sites that are limited even in the scope of outpatient services provided. Compared with other urban populations, urban American Indian and Alaska Native women have higher rates of teenaged pregnancy, late or no prenatal care, and alcohol and tobacco use in pregnancy. Their infants have higher rates of preterm birth, mortality, and sudden infant death syndrome than infants in the general population. Barriers to care experienced by American Indian and Alaska Native women should be addressed. The American College of Obstetricians and Gynecologists encourages Fellows to be aware of the risk profile of their urban American Indian and Alaska Native patients and understand that they often are not eligible for IHS coverage and may need assistance in gaining access to other forms of coverage. The American College of Obstetricians and Gynecologists also recommends that Fellows encourage their federal legislators to support adequate funding for the Indian Health Care Improvement Act, permanently authorized as part of the Patient Protection and Affordable Care Act.

Health Care Systems for Underserved Women

resources@acog.org — Fri, 18 Jan 2013 15:48:00 -0500

ABSTRACT: Underserved women are those who are unable to obtain quality health care by virtue of barriers created by poverty, cultural differences, race or ethnicity, geography, sexual orientation, gender identity, or other factors that contribute to health care inequities. With passage of the Patient Protection and Affordable Care Act Public Law 111–148 and 152, there is promise for increased health insurance coverage for underserved women. There is concern, however, that specific populations of underserved women may be left out. These women must continue to have access to existing safety net health care providers and to new models of care with systems that support integrated service delivery and improved care coordination.

Communication Strategies for Patient Handoffs

resources@acog.org — Fri, 18 Jan 2013 15:46:01 -0500

ABSTRACT: Handoff communication, which includes up-to-date information regarding patient care, treatment and service, condition, and any recent or anticipated changes, should be interactive to allow for discussion between those who give and receive patient information. It requires a process for verification of the received information, including read-back or other methods, as appropriate.

Intimate Partner Violence

resources@acog.org — Fri, 18 Jan 2013 15:45:17 -0500

ABSTRACT: Intimate partner violence (IPV) is a significant yet preventable public health problem that affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background. Individuals who are subjected to IPV may have lifelong consequences, including emotional trauma, lasting physical impairment, chronic health problems, and even death. Although women of all ages may experience IPV, it is most prevalent among women of reproductive age and contributes to gynecologic disorders, pregnancy complications, unintended pregnancy, and sexually transmitted infections, including human immunodeficiency virus (HIV). Obstetrician–gynecologists are in a unique position to assess and provide support for women who experience IPV because of the nature of the patient–physician relationship and the many opportunities for intervention that occur during the course of pregnancy, family planning, annual examinations, and other women’s health visits. The U.S. Department of Health and Human Services has recommended that IPV screening and counseling should be a core part of women’s preventive health visits. Physicians should screen all women for IPV at periodic intervals, including during obstetric care (at the first prenatal visit, at least once per trimester, and at the postpartum checkup), offer ongoing support, and review available prevention and referral options. Resources are available in many communities to assist women who experience IPV.

Fatigue and Patient Safety

resources@acog.org — Fri, 18 Jan 2013 15:44:15 -0500

ABSTRACT: It has long been recognized that fatigue can affect human cognitive and physical function. Although there are limited published data on the effects of fatigue on health care providers, including full-time practicing physicians, there is increasing awareness within the patient safety movement that fatigue, even partial sleep deprivation, impairs performance.

Disclosure and Discussion of Adverse Events

resources@acog.org — Fri, 18 Jan 2013 15:43:28 -0500

ABSTRACT: Disclosure and discussion of adverse events in health care with the patient are morally and ethically necessary to achieve the optimal goal of respecting patient autonomy. Improving the disclosure process through education, policies, programmatic training, and accessible resources will enhance patient satisfaction, strengthen the physician–patient relationship, reduce physician stress, and, most importantly, promote safe and high-quality health care.

Update on Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination

resources@acog.org — Fri, 18 Jan 2013 15:42:29 -0500

ABSTRACT: In light of the recent increased incidence of pertussis in the United States, in 2011, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices approved recommendations for the use of the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) for pregnant women. Furthermore, the committee updated Tdap recommendations for special situations during pregnancy and for persons in contact with infants. The revised guidelines, which are based on a review of data on Tdap safety, immunogenicity, and barriers to receipt of Tdap, are designed to facilitate the use of Tdap to reduce the burden of disease and risk of transmission to infants. There is no evidence of adverse fetal effects from the vaccination of pregnant women with an inactivated virus, bacterial vaccine, or toxoid, and these should be administered if indicated. The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice supports the revised recommendations on the administration of Tdap during pregnancy.

Re-entering the Practice of Obstetrics and Gynecology

resources@acog.org — Fri, 18 Jan 2013 15:41:52 -0500

ABSTRACT: Re-entering the practice of obstetrics and gynecology after a period of inactivity can pose a number of obstacles for a physician. Preparing for the leave of absence may help reduce the difficulties physicians may face upon re-entering practice.

Health Care for Lesbians and Bisexual Women

resources@acog.org — Fri, 18 Jan 2013 15:36:49 -0500

ABSTRACT: Lesbians and bisexual women encounter barriers to health care that include concerns about confidentiality and disclosure, discriminatory attitudes and treatment, limited access to health care and health insurance, and often a limited understanding as to what their health risks may be. Health care providers should offer quality care to all women regardless of sexual orientation. The American College of Obstetricians and Gynecologists endorses equitable treatment for lesbians and bisexual women and their families, not only for direct health care needs, but also for indirect health care issues.

Standardization of Practice to Improve Outcomes

resources@acog.org — Fri, 18 Jan 2013 15:34:12 -0500

ABSTRACT: Protocols and checklists have been shown to improve patient safety through standardization and communication. Standardization of practice to improve quality outcomes is an important tool in achieving the shared vision of patients and their health care providers.

Personalized Genomic Testing for Disease Risk

resources@acog.org — Fri, 18 Jan 2013 15:32:29 -0500

ABSTRACT: Advances in genetic technologies have led to the identification of hundreds of single nucleotide polymorphisms that are associated with a variety of complex diseases, including cancer, diabetes, cardiovascular disease, and Alzheimer disease. Although personalized genomic tests that provide information regarding the risk of development of multiple diseases may be important tools in the near future, their use is not recommended outside of a clinical trial until these tests are validated as clinically useful in appropriately designed prospective studies. Testing for single-gene disorders should be approached in accordance with accepted guidelines that address the evaluation and management of these specific diseases.

Adoption

resources@acog.org — Fri, 18 Jan 2013 15:31:41 -0500

ABSTRACT: Obstetrician–gynecologists may find themselves at the center of adoption issues because of their expertise in the assessment and management of infertility, pregnancy, and childbirth. The lack of clarity about both ethical issues and legal consequences may create challenges for physicians. Therefore, the Committee on Ethics of the American College of Obstetricians and Gynecologists discusses ethical issues, proposes safeguards, and makes recommendations regarding the role of the physician in adoption.

Placenta Accreta

resources@acog.org — Fri, 18 Jan 2013 15:30:45 -0500

ABSTRACT: Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Grayscale ultrasonography is sensitive enough and specific enough for the diagnosis of placenta accreta; magnetic resonance imaging may be helpful in ambiguous cases. Although recognized obstetric risk factors allow the identification of most cases during the antepartum period, the diagnosis is occasionally discovered at the time of delivery. In general, the recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ because attempts at removal of the placenta are associated with significant hemorrhagic morbidity. However, surgical management of placenta accreta may be individualized. Although a planned delivery is the goal, a contingency plan for an emergency delivery should be developed for each patient, which may include following an institutional protocol for maternal hemorrhage management.

Access to Postpartum Sterilization

resources@acog.org — Fri, 18 Jan 2013 15:29:51 -0500

ABSTRACT: Postpartum tubal sterilization is one of the safest and most effective methods of contraception. Women who desire this type of sterilization typically undergo thorough counseling and informed consent during prenatal care and reiterate their desire for postpartum sterilization at the time of their hospital admission. Not all women who desire postpartum sterilization actually undergo the surgical procedure, and women with unfulfilled requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year. Potentially correctable barriers to obtaining postpartum sterilization include patient and health care provider factors, as well as hospital and health care system issues. Given the consequences of a missed procedure and the limited time frame in which it may be performed, postpartum sterilization should be considered an urgent surgical procedure. In addition, women with government insurance face barriers to sterilization procedures based on cumbersome consent requirements. The differences in the requirements surrounding consent for sterilization procedures based on the type of insurance a patient has must be addressed in order to establish fair and equitable access to sterilization procedures for all women. Policies and procedures that remove barriers to and increase efficiency in performing postpartum sterilization could reduce cancellations of the procedure. Improving consistency in accomplishing desired postpartum sterilization is an important strategy to reduce high rates of unintended pregnancy in the United States.

Improving Medication Safety

resources@acog.org — Fri, 18 Jan 2013 15:28:24 -0500

ABSTRACT: Despite significant national attention, medical errors continue to pervade the U.S. health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches that, along with efforts directed at assisting the patient in understanding the medical condition for which a medication is prescribed, can improve the safety and efficacy of medication use.

Lead Screening During Pregnancy and Lactation

resources@acog.org — Fri, 18 Jan 2013 15:23:18 -0500

ABSTRACT: Prenatal lead exposure has known adverse effects on maternal health and infant outcomes across a wide range of maternal blood lead levels. Adverse effects of lead exposure are being identified at lower levels of exposure than previously recognized in both children and adults. In 2010, the Centers for Disease Control and Prevention issued the first guidelines regarding the screening and management of pregnant and lactating women who have been exposed to lead.

Well-Woman Visit

resources@acog.org — Fri, 18 Jan 2013 15:22:11 -0500

ABSTRACT: The annual health assessment (“annual examination”) is a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician–patient relationship. The annual health assessment should include screening, evaluation and counseling, and immunizations based on age and risk factors. The interval for specific individual services and the scope of services provided may vary in different ambulatory care settings. The performance of a physical examination is a key part of an annual health assessment visit, and the components of that examination may vary depending on the patient’s age, risk factors, and physician preference. The American College of Obstetricians and Gynecologists explains the need for annual assessments and provides guidelines regarding some important elements of the annual examination; specifically, when to perform pelvic examinations in asymptomatic women, including when to start internal pelvic and speculum examinations, and when to initiate formal clinical breast examinations.

Reproductive Health Care for Incarcerated Women and Adolescent Females

resources@acog.org — Fri, 18 Jan 2013 15:21:28 -0500

ABSTRACT: Increasing numbers of women and adolescent females are incarcerated each year in the United States and they represent an increasing proportion of inmates in the U.S. correctional system. Incarcerated women and adolescent females often come from disadvantaged environments and have high rates of chronic illness, substance abuse, and undetected health problems. Most of these females are of reproductive age and are at high risk of unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). Understanding the needs of incarcerated women and adolescent females can help improve the provision of health care in the correctional system.

Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome and Women of Color

resources@acog.org — Fri, 18 Jan 2013 15:17:36 -0500

ABSTRACT: In the United States, most new cases of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) occur among women of color (primarily African American and Hispanic women). Most women of color acquire the disease from heterosexual contact, often from a partner who has undisclosed risk factors for HIV infection. Safe sex practices, especially consistent condom use, must be emphasized for all women, including women of color. A combination of testing, education, and brief behavioral interventions can help reduce the rate of HIV infection and its complications among women of color. In addition, biomedical interventions such as early treatment of patients infected with HIV and pre-exposure antiretroviral prophylaxis of high-risk individuals offer promise for future reductions in infections.

Reprocessed Single-Use Devices

resources@acog.org — Fri, 18 Jan 2013 15:16:28 -0500

ABSTRACT: The reprocessing and reuse of single-use instruments has become increasingly common. Although there are limited data on reprocessed single-use devices, existing studies have found a significant rate of physical defects, performance issues, or improper decontamination. There are currently no data in the medical literature of studies evaluating the cost-effectiveness of reprocessed single-use devices in gynecologic surgery. The use of a reprocessed single-use device provides no direct benefit to an individual patient or her physician. It is the operating surgeon’s ethical responsibility to make a good faith effort to know whether reprocessed single-use devices are to be used, and to not use instruments if he or she has concerns about the quality or safety of the instrument(s). Studies on the safety, quality, and cost-effectiveness of reprocessed single-use devices in gynecologic surgery are needed. Physicians should be informed whether the instruments used in surgery are original or reprocessed, and adverse events should be reported to improve the safety information about reprocessed single-use devices.

Nonmedical Use of Prescription Drugs

resources@acog.org — Fri, 18 Jan 2013 15:15:19 -0500

ABSTRACT: The nonmedical use of prescription drugs, particularly opioids, sedatives, and stimulants, has been cited as epidemic in the United States, accounting for increasing numbers of emergency department visits and deaths from reactions and overdoses. The prevalence of prescription drug abuse is similar among men and women. Those who abuse prescription drugs most often obtain them from friends and family either through sharing or theft. Physicians should screen all patients annually and early in prenatal care with a validated questionnaire for the nonmedical use of prescription drugs. They should provide preventive education for all patients and referral for treatment, when psychologic or physical drug dependence is identified. Physicians should also educate patients in the proper use, storage, and disposal of prescription drugs.

Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices

resources@acog.org — Fri, 18 Jan 2013 15:13:55 -0500

ABSTRACT: Long-acting reversible contraception (LARC)—intrauterine devices and the contraceptive implant—are safe and appropriate contraceptive methods for most women and adolescents. The LARC methods are top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1% per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to LARC methods.

Risk of Venous Thromboembolism Among Users of Drospirenone-Containing Oral Contraceptive Pills

resources@acog.org — Fri, 18 Jan 2013 15:11:38 -0500

ABSTRACT: Although the risk of venous thromboembolism is increased among oral contraceptive users compared with nonusers who are not pregnant and not taking hormones, and some data have suggested that use of drospirenone-containing pills has a higher risk of venous thromboembolism, this risk is still very low and is much lower than the risk of venous thromboembolism during pregnancy and the immediate postpartum period. When prescribing any oral contraceptive, clinicians should consider a woman’s risk factors for venous thromboembolism and refer to the U.S. Medical Eligibility Criteria for Contraceptive Use issued by the Centers for Disease Control and Prevention. Patient education materials, including product labeling, should place information regarding oral contraceptive use and venous thromboembolism risks in context by also providing information about overall venous thromboembolism risks and venous thromboembolism risks during pregnancy and the postpartum period. Decisions regarding choice of oral contraceptive should be left to clinicians and their patients, taking into account the possible minimally increased risk of venous thromboembolism, patient preference, and available alternatives.

Professional Relationships With Industry

resources@acog.org — Fri, 18 Jan 2013 15:06:21 -0500

ABSTRACT: The American College of Obstetricians and Gynecologists (the College) has a long history of leadership in ensuring that its educational mission is evidence based and unbiased. A predecessor to this Committee Opinion was published in 1985, making the College one of the first professional associations to provide guidance on this issue. The College has continued to update the ethical guidance on physician interactions with industry periodically. Obstetrician–gynecologists’ relationships with industry should be structured in a manner that will enhance, rather than detract from, their obligations to their patients. The ideal behaviors set forth in this Committee Opinion will contribute toward maintaining patient trust in the specialty and avoiding conflicts of interest by College members.

Access to Emergency Contraception

resources@acog.org — Fri, 18 Jan 2013 15:02:28 -0500

ABSTRACT: Emergency contraception includes contraceptive methods used to prevent pregnancy in the first few days after unprotected intercourse, sexual assault, or contraceptive failure. Although the U.S. Food and Drug Administration approved the first dedicated product for emergency contraception in 1998, numerous barriers to access to emergency contraception remain. The purpose of this Committee Opinion is to examine the barriers to the use of oral emergency contraception methods and to highlight the importance of increasing access.

Timing of Umbilical Cord Clamping After Birth

resources@acog.org — Fri, 18 Jan 2013 15:01:26 -0500

ABSTRACT: The optimal timing for clamping the umbilical cord after birth has been a subject of controversy and debate. Although many randomized controlled trials in term and preterm infants have evaluated the benefits of delayed umbilical cord clamping versus immediate umbilical cord clamping, the ideal timing for cord clamping has yet to be established. Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30–60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits, including increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and lower frequency of iron deficiency anemia in term infants. Evidence exists to support delayed umbilical cord clamping in preterm infants, when feasible. The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular hemorrhage. However, currently, evidence is insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.

Over-the-Counter Access to Oral Contraceptives

resources@acog.org — Fri, 18 Jan 2013 14:59:49 -0500

ABSTRACT: Unintended pregnancy remains a major public health problem in the United States. Access and cost issues are common reasons why women either do not use contraception or have gaps in use. A potential way to improve contraceptive access and use, and possibly decrease unintended pregnancy rates, is to allow over-the-counter access to oral contraceptives (OCs). Screening for cervical cancer or sexually transmitted infections is not medically required to provide hormonal contraception. Concerns include payment for pharmacist services, payment for over-the-counter OCs by insurers, and the possibility of pharmacists inappropriately refusing to provide OCs. Weighing the risks versus the benefits based on currently available data, OCs should be available over-the-counter. Women should self-screen for most contraindications to OCs using checklists.

Noninvasive Prenatal Testing for Fetal Aneuploidy

resources@acog.org — Fri, 18 Jan 2013 14:58:55 -0500

ABSTRACT: Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women offers tremendous potential as a screening tool for fetal aneuploidy. Cell free fetal DNA testing should be an informed patient choice after pretest counseling and should not be part of routine prenatal laboratory assessment. Cell free fetal DNA testing should not be offered to low-risk women or women with multiple gestations because it has not been sufficiently evaluated in these groups. A negative cell free fetal DNA test result does not ensure an unaffected pregnancy. A patient with a positive test result should be referred for genetic counseling and should be offered invasive prenatal diagnosis for confirmation of test results.

Tracking and Reminder Systems

resources@acog.org — Fri, 18 Jan 2013 14:15:00 -0500

ABSTRACT: An accurate and effective tracking or reminder system is useful for the modern practice of obstetrics and gynecology. Practices should not rely solely on the patient to complete all ordered studies and to follow up on health care provider recommendations. Health care providers should encourage their patients to complete studies believed essential for patient care within an acceptable time frame. Each office should establish a simple, reliable tracking and reminder system to facilitate communication, improve patient safety and quality of care, and minimize missed or delayed diagnoses.

Health Care for Women in the Military and Women Veterans

resources@acog.org — Fri, 18 Jan 2013 14:13:53 -0500

Abstract: Military service is associated with unique risks to women’s reproductive health. As increasing numbers of women are serving in the military, and a greater proportion of United States Veterans are women, it is essential that obstetrician–-gynecologists are aware of and well prepared to address the unique health care needs of this demographic group. Obstetrician–-gynecologists should ask about women’s military service, know the Veteran status of their patients, and be aware of high prevalence problems (eg, posttraumatic stress disorder, intimate partner violence, and military sexual trauma) that can threaten the health and well-being of these women. Additional research examining the effect of military and Veteran status on reproductive health is needed to guide the care for this population. Moreover, partnerships between academic departments of obstetrics and gynecology and local branches of the Veterans Health Administration are encouraged as a means of optimizing the provision of comprehensive health care to this unique group of women.

Benefits to Women of Medicaid Expansion Through the Affordable Care Act

resources@acog.org — Fri, 18 Jan 2013 14:12:11 -0500

ABSTRACT: Many U.S. women are uninsured and face avoidable adverse obstetric and gynecologic health outcomes. The Affordable Care Act requires an expansion of Medicaid that would increase the percentage of U.S. women with health insurance, with the anticipated benefit of improved health. The 2012 Supreme Court decision allows states to opt out of Medicaid expansion. The American College of Obstetricians and Gynecologists supports appropriate reimbursement to health care providers and the expansion of Medicaid as key strategies to improve women’s health.

Coping With the Stress of Medical Professional Liability Litigation

resources@acog.org — Fri, 18 Jan 2013 14:11:32 -0500

ABSTRACT: Obstetrician–gynecologists should recognize that being a defendant in a medical professional liability lawsuit can be one of life’s most stressful experiences. Negative emotions in response to a lawsuit are normal, and physicians may need help from family members, peers, or professionals to cope with this stress. Open communication will assist in reducing emotional isolation and self-blame. However, pertinent legal and clinical aspects of a case must be kept confidential, except for disclosure within the confines of a protected counselor–patient relationship as determined by state law.

Maternal–Fetal Surgery for Myelomeningocele

resources@acog.org — Fri, 18 Jan 2013 14:10:57 -0500

ABSTRACT: Myelomeningocele, the most severe form of spina bifida, occurs in approximately 1 in 1,500 births in the United States. Fetuses in whom myelomeningocele is diagnosed typically are delivered at term and are treated in the early neonatal period. A recent randomized controlled trial found that fetal surgery for myelomeningocele improved a number of important outcomes, but also was associated with maternal and fetal risks. Maternal–fetal surgery is a major procedure for the woman and her fetus, and it has significant implications and complications that occur acutely, postoperatively, for the duration of the pregnancy, and in subsequent pregnancies. Therefore, it should only be offered at facilities with the expertise, multidisciplinary teams, services, and facilities to provide the intensive care required for these patients.

Obesity in Pregnancy

resources@acog.org — Fri, 18 Jan 2013 14:10:07 -0500

ABSTRACT: In the United States, more than one third of women are obese, more than one half of pregnant women are overweight or obese, and 8% of reproductive-aged women are extremely obese, putting them at a greater risk of pregnancy complications. Therefore, preconception assessment and counseling are strongly encouraged for obese women and should include the provision of specific information concerning the maternal and fetal risks of obesity in pregnancy, as well as encouragement to undertake a weight-reduction program. At the initial prenatal visit, height and weight should be recorded for all women to allow calculation of body mass index (calculated as weight in kilograms divided by height in meters squared), and recommendations for appropriate weight gain should be reviewed at the initial visit and periodically throughout pregnancy. Nutrition consultation should be offered to all overweight or obese women, and they should be encouraged to follow an exercise program. Pregnant women who have undergone bariatric surgery should be evaluated for nutritional deficiencies and the need for vitamin supplementation when indicated. Obese patients undergoing cesarean delivery may require thromboprophylaxis with pneumatic compression devices and unfractionated heparin or low molecular weight heparin. For all obese patients, anesthesiology consultation early in labor should be considered, and consultation with weight-reduction specialists before attempting another pregnancy should be encouraged.

Weight Gain During Pregnancy

resources@acog.org — Fri, 18 Jan 2013 13:58:33 -0500

ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less weight than recommended but has an appropriately growing fetus.

A Healthy Pregnancy for Women With Diabetes

resources@acog.org — Thu, 17 Jan 2013 16:00:29 -0500

If you have type 1 or type 2 diabetes mellitus, you need to plan for pregnancy. Women with poorly controlled diabetes are at risk of several pregnancy problems. These risks can be greatly reduced if you take steps to become as healthy as you can before pregnancy and manage your health during pregnancy.

Alcohol and Women

resources@acog.org — Thu, 17 Jan 2013 16:00:07 -0500

More than one half of all women in the United States drink alcohol. If you drink alcohol, you should know how it can put you at risk of health problems. Many women who are at-risk drinkers are surprised to learn that their drinking exceeds a safe level.

Barrier Methods of Contraception

resources@acog.org — Thu, 17 Jan 2013 15:59:57 -0500

Barrier methods are among the safest forms of contraception (birth control). These methods act as barriers to keep the man's sperm from reaching the woman's egg. Some methods also protect against sexually transmitted diseases (STDs).

Birth Control -- Especially for Teens

resources@acog.org — Thu, 17 Jan 2013 15:59:26 -0500

Making the decision whether to have sex can be difficult. You should make up your own mind when the time is right for you. If you are not ready for sex, say so. If you think you are ready to have sex or if you are already having sex—even only now and then—you should take steps to avoid pregnancy and sexually transmitted diseases (STDs). Thousands of teens become pregnant each year because they do not use birth control or they do not use it correctly.

Birth Control Pills

resources@acog.org — Thu, 17 Jan 2013 15:58:59 -0500

Birth control pills (also called oral contraceptives or “the pill”) are used by millions of women in the United States to prevent pregnancy. For most women, the pill is a safe and highly effective form of birth control.

Bleeding During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:58:48 -0500

Vaginal bleeding in pregnancy has many causes. Some are serious and some are not. Bleeding can occur early or later in pregnancy. Slight bleeding often stops on its own. Sometimes, bleeding may pose a risk to you or your fetus. You should call your doctor or seek medical advice any time that bleeding occurs.

Bowel Control Problems

resources@acog.org — Thu, 17 Jan 2013 15:58:15 -0500

Bowel control problems affect at least 1 million people in the United States. Loss of normal control of the bowels is called fecal incontinence. This leads to leakage of solid or liquid stool (feces) or gas.

Cancer of the Cervix

resources@acog.org — Thu, 17 Jan 2013 15:57:52 -0500

An estimated 12,000 new cases of cervical cancer occur each year in the United States, and each year about 4,000 U.S. women will die from this disease. Cervical cancer is largely preventable by having regular cervical cancer screening. About one half of cervical cancer cases occur in women who have never had screening.

Cancer of the Ovary

resources@acog.org — Thu, 17 Jan 2013 15:57:41 -0500

Cancer of the ovary is a disease that affects one or both ovaries, the two glands on either side of the uterus. About 22,000 new cases of ovarian cancer are diagnosed each year in the United States. It is the fifth leading cause of cancer deaths in women.

Cancer of the Uterus

resources@acog.org — Thu, 17 Jan 2013 15:57:17 -0500

The uterus is made up of three parts: the muscle wall, the endometrium (lining), and the cervix (opening). Cancer of the uterus affects the muscle and endometrium, and in some cases, the cervix. It is good to know the risk factors and the warning signs. If the cancer is found and treated early, as many as 9 out of every 10 women who have it can be cured.

Cervical Cancer Screening

resources@acog.org — Thu, 17 Jan 2013 15:56:56 -0500

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for human papillomavirus (HPV). Most women should have cervical cancer screening on a regular basis.

Cesarean Birth

resources@acog.org — Thu, 17 Jan 2013 15:56:45 -0500

Most babies enter the world through the birth canal (vagina). However, in about one third of cases, a baby is born by cesarean delivery. This means the baby is delivered through an incision in the mother’s abdomen and uterus.

Cord Blood Banking

resources@acog.org — Thu, 17 Jan 2013 15:56:01 -0500

Cord blood is the blood from the baby that is left in the umbilical cord and placenta after birth. It contains cells called hematopoietic (blood-forming) stem cells that can be used to treat some diseases. It is now possible to donate cord blood to a public bank or store it in a private bank for future use.

Cystic Fibrosis Prenatal Screening and Diagnosis

resources@acog.org — Thu, 17 Jan 2013 15:55:50 -0500

Cystic fibrosis (CF) is a genetic disorder that causes problems with breathing and digestion. It is caused by an abnormal gene that is passed from parent to child. There is no cure for CF, but it can be treated. Testing can be done to see if a person carries the gene and if there is a risk of passing it on to a child.

Depression

resources@acog.org — Thu, 17 Jan 2013 15:55:34 -0500

Feeling unhappy or sad now and then is normal. These feelings usually go away within a few hours or days. When a person has depression, however, the feelings last longer and interfere with daily life. Depression can affect anyone, but women are more likely to be depressed than men. About 10% of women in the United States have signs and symptoms of depression.

Diabetes and Women

resources@acog.org — Thu, 17 Jan 2013 15:55:22 -0500

More than 20 million Americans have diabetes (also called diabetes mellitus). In this condition, high levels of glucose are present in the blood. Health problems can arise if blood glucose levels are not controlled. Almost one third of people with diabetes do not even know they have it. Knowing whether you have risk factors, following recommended guidelines for screening tests, and recognizing the warning signs may help you avoid the serious complications of this disease.

Dilation and Curettage

resources@acog.org — Thu, 17 Jan 2013 15:54:58 -0500

Dilation and curettage (D&C) is a surgical procedure that is used to diagnose and treat many conditions that after the uterus. Dilation means to open the cervix so that a thin instrument can be introduced into the uterus for the procedure. Curettage involves removing tissue from the inside of the uterus.

Dysmenorrhea

resources@acog.org — Thu, 17 Jan 2013 15:54:22 -0500

Pain associated with menstruation is called dysmenorrhea. Dysmenorrhea is the most commonly reported menstrual disorder. More than one half of women who menstruate have some pain for 1–2 days each month. Usually, the pain is mild. But for some women, the pain is so severe that it prevents them from doing their normal, day-to-day activities for several days a month.

Early Pregnancy Loss Miscarriage and Molar Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:54:10 -0500

A normal pregnancy is about 40 weeks. The loss of a pregnancy before 20 weeks is called early pregnancy loss. Often, the loss is a miscarriage (sometimes called spontaneous abortion by doctors). A rare form of pregnancy loss is molar pregnancy.

Early Preterm Birth

resources@acog.org — Thu, 17 Jan 2013 15:53:58 -0500

Most pregnancies last about 40 weeks. Babies born between 32 and 37 weeks of pregnancy are considered preterm. Babies born before 32 weeks are called “early preterm.” The earlier a baby is born, the less likely he or she is to survive. Those who do survive are at increased risk for lifelong health problems.

Easing Back Pain During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:53:44 -0500

Back pain is one of the most common discomforts during pregnancy. As your baby grows, your uterus expands to as much as 1,000 times its original size. This amount of growth—when centered in one area—affects the balance of your body and may cause discomfort.

Ectopic Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:53:32 -0500

In most cases a woman’s egg is fertilized by a man’s sperm in one of her fallopian tubes. The fertilized egg then moves through the tube to the lining of the uterus, where it implants and starts to grow. An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Because it is outside of the uterus, an ectopic pregnancy cannot grow as it should and must be treated.

Emergency Contraception

resources@acog.org — Thu, 17 Jan 2013 15:52:51 -0500

Emergency contraception is used to prevent a woman from getting pregnant after she has had sex without using birth control, if her current method fails, or if she is raped. There are two forms of emergency contraception available in the United States: 1) emergency contraceptive pills and 2) the copper intrauterine device (IUD).

Endometrial Ablation

resources@acog.org — Thu, 17 Jan 2013 15:52:40 -0500

The lining of the uterus—the endometrium—is shed by bleeding each month during menstruation. Some women have heavy bleeding or bleeding that lasts longer than normal. For them, endometrial ablation may be a good treatment option. This procedure treats the lining of the uterus to control or stop bleeding. It does not involve removal of the uterus and it does not affect a woman’s hormone levels.

Endometriosis

resources@acog.org — Thu, 17 Jan 2013 15:52:14 -0500

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus. It occurs in about one in ten women of reproductive age. Many women with endometriosis have no symptoms or only mild discomfort. Others have pain that is so severe that it prevents them from doing their normal activities. Endometriosis also is a leading cause of infertility.

Evaluating Infertility

resources@acog.org — Thu, 17 Jan 2013 15:52:03 -0500

If you are trying to have a child and you have not become pregnant, you may need an infertility evaluation. An infertility evaluation is recommended if you have not become pregnant after 1 year of having regular sexual intercourse without the use of birth control, or after 6 months if you are older than 35 years.

During an infertility evaluation, exams and tests are done to try to find the cause of the problem. If a cause is found, treatment may be possible. In many cases, infertility can be successfully treated even if no cause is found.

Exercise and Fitness

resources@acog.org — Thu, 17 Jan 2013 15:51:52 -0500

Regular physical activity—exercise that is done on most days of the week—has many health benefits. It can help you prevent or control disease, lose weight, and feel better. Exercise is key to a healthy lifestyle.

Exercise During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:51:26 -0500

Regular exercise builds bones and muscles, gives you energy, and keeps you healthy. It is just as important when you are pregnant.

Genital Herpes

resources@acog.org — Thu, 17 Jan 2013 15:50:46 -0500

Genital herpes is a viral infection that can be spread through sexual contact. It affects one in five adults in the United States—about 45 million people. It is more common in women than in men.

Gestational Diabetes

resources@acog.org — Thu, 17 Jan 2013 15:50:34 -0500

Diabetes mellitus (also called “diabetes”) is a condition that causes high levels of glucose in the blood. Glucose is a sugar that is the body’s main source of energy. Health problems can occur when glucose levels are too high. Some women develop diabetes for the first time during pregnancy. This condition is called gestational diabetes. Women with gestational diabetes need special care both during and after pregnancy.

Getting in Shape After Your Baby is Born

resources@acog.org — Thu, 17 Jan 2013 15:50:16 -0500

Having a baby and taking care of a newborn are hard work. It will take a while to regain your strength after the strain of pregnancy and birth. You should allow your body time to recover. But, as soon as you feel up to it, talk to your doctor about when you can start an exercise program.

Gonorrhea, Chlamydia, and Syphilis

resources@acog.org — Thu, 17 Jan 2013 15:50:02 -0500

Gonorrhea and chlamydia are two of the most common sexually transmitted diseases (STDs). Syphilis, another STD, was uncommon until 2001, when cases began to increase. These three STDs can cause serious, long-term problems if they are not treated, especially for teenagers and young women. It is important to learn how to recognize the signs and symptoms of these STDs and take steps to prevent them.

Good Health Before Pregnancy Preconceptional Care

resources@acog.org — Thu, 17 Jan 2013 15:49:50 -0500

Planning your pregnancy can help you make wise choices that will benefit both you and your baby. Many women do not know they are pregnant until they are several weeks into their pregnancies. The first 8 weeks of pregnancy are key for the baby growing inside you. Most of the baby’s major organs and body systems have begun to form. Your health and nutrition can affect your baby’s growth and development in these early weeks. That is why preparing for pregnancy (called preconception care) is so important.

Group B Streptococcus and Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:49:37 -0500

Group B streptococcus (GBS) is a type of bacteria that is found in 10–30% of pregnant women. A woman with GBS can pass it to her baby during labor and delivery. Most babies who get GBS from their mothers do not have any problems. A few, however, will become sick. This illness can cause serious health problems and even death in newborn babies. It usually can be prevented with a routine screening test that is given during prenatal care.

Having a Baby-Especially for Teens

resources@acog.org — Thu, 17 Jan 2013 15:49:26 -0500

Pregnancy and childbirth change your life. When you are pregnant, you must care for and think about two people—yourself and your baby.

Healthy Eating

resources@acog.org — Thu, 17 Jan 2013 15:49:01 -0500

Eating well is one of the best things you can do to stay healthy. A good diet gives you more energy, improves your physical and mental well-being, and decreases your risk of disease.

Hepatitis B Virus in Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:48:51 -0500

Infection with hepatitis B virus can cause major health problems. A person infected with this virus may not show any signs of being infected, but can pass it on to others.

High Blood Pressure During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:48:39 -0500

Normal blood pressure levels are key to good health. When blood pressure becomes too high, it is known as hypertension. This can pose health risks at any time. During pregnancy, hypertension can cause added problems. In some cases, preeclampsia, a serious disorder that affects pregnancy, may develop. If you are pregnant and have any of the risk factors that may lead to high blood pressure, you may need special care.

HIV and Women

resources@acog.org — Thu, 17 Jan 2013 15:48:10 -0500

The human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS). Many people think AIDS is a disease that affects only homosexual (gay) men and intravenous (IV) drug users. This is not true. The rate of HIV infection is increasing most rapidly among heterosexual women. HIV infection is the fifth leading cause of death among women 19–39 years of age.

How to Prevent Sexually Transmitted Diseases

resources@acog.org — Thu, 17 Jan 2013 15:47:46 -0500

Sexually transmitted diseases (STDs) are infections that are spread by sexual contact. Except for colds and flu, STDs are the most common contagious (easily spread) diseases in the United States, with millions of new cases each year. Although some STDs can be treated and cured, others cannot. Prevention is the key to fighting STDs. By knowing the facts, you can take steps to protect your health.

How to Tell When Labor Begins

resources@acog.org — Thu, 17 Jan 2013 15:47:27 -0500

Awaiting the birth of a baby is an exciting and anxious time. The average length of pregnancy is 280 days, or 40 weeks. However, there is no way to know exactly when you will go into labor. Most women give birth between 38 weeks and 41 weeks of pregnancy.

How Your Baby Grows During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:47:14 -0500

Pregnancy is a time of major change. From the very start, your unborn baby (fetus) alters your body and the way you live. For your entire pregnancy, the baby depends on you for all the things it needs to grow and thrive. Although each pregnancy is unique, the growth and development of a fetus take place in a fairly standard pattern. Month by month, you and your baby prepare for birth and a new life.

Human Papillomavirus (HPV) Infection

resources@acog.org — Thu, 17 Jan 2013 15:47:00 -0500

Infection with human papillomavirus (HPV) is very common in both women and men. More than 100 types of HPV have been found, and about 30 of these types are spread from person to person through sexual contact. Some types of HPV cause genital warts, while others cause cancer of the cervix. Two vaccines are available that can protect against some of these HPV types.

Human Papillomavirus Vaccines

resources@acog.org — Thu, 17 Jan 2013 15:46:47 -0500

Infection with human papillomavirus (HPV) is very common in both women and men. Of the more than 100 types of this virus, about 30 are spread from person to person through sexual contact. Some types of HPV cause genital warts, while others cause cancer of the cervix. It is estimated that at least three out of four people who are sexually active will get an HPV infection during their lifetime. There are things you can do to protect yourself against HPV infection. One is to be vaccinated against certain types of HPV.

Hysteroscopic Sterilization

resources@acog.org — Thu, 17 Jan 2013 15:46:09 -0500

Sterilization is a permanent form of birth control. It is the second most popular form of birth control in the United States after the birth control pill. Hysteroscopic sterilization is a procedure that uses the body’s natural openings to place small implants into the fallopian tubes. These implants cause tissue growth that blocks the tubes. No surgical incision is needed. It is a safe procedure with few complications.

If Your Baby Is Breech

resources@acog.org — Thu, 17 Jan 2013 15:45:47 -0500

Before birth, most babies move into a head-down position in the uterus. Some do not. When the buttocks, feet, or both are in place to come out first during birth it is called breech presentation.

If your baby is in the breech presentation when your due date is near, you should know what to expect. You then can plan with your doctor the best way to manage your labor and delivery.

Implants Injections Rings and Patches-Hormonal Birth Control Options

resources@acog.org — Thu, 17 Jan 2013 15:45:37 -0500

Besides oral contraceptives (birth control pills) and the hormonal intrauterine device, there are several other forms of hormonal birth control: implants, injections, rings, and patches. These methods are effective in preventing pregnancy and are a good choice for many women.

Induced Abortion

resources@acog.org — Thu, 17 Jan 2013 15:43:53 -0500

Each year, about 1.2 million women in the United States have an abortion to end a pregnancy. The procedure is low risk when done early and in the proper setting. Having an abortion is a big decision that should be well thought out. Talking with your partner, a family member, or a close friend can be helpful. Your doctor or counselor can answer questions and explain the procedure.

It's Time To Quit Smoking

resources@acog.org — Thu, 17 Jan 2013 15:43:42 -0500

You can be one of the millions of women who have quit smoking. There are more options now than ever to help you quit. Quitting smoking can make you look better and feel better. It is also one of the best things that you can do for your health.

Labor Induction

resources@acog.org — Thu, 17 Jan 2013 15:43:17 -0500

Labor is the process that leads to the birth of a baby. Labor usually starts on its own. Labor induction is the use of medications or other methods to bring on (induce) labor. More than 20% of pregnant women in the United States have labor induced.

Later Childbearing

resources@acog.org — Thu, 17 Jan 2013 15:42:53 -0500

Today, more couples are starting families later in life. Older women often worry that their age will affect their fertility and the health of their babies. There is no set age that is unsafe for women to become pregnant. For women aged 35 years and older, the chances of having a normal pregnancy and healthy baby are great — especially if they get good preconception and prenatal care. Even so, older women often have to deal with issues during pregnancy that do not apply to younger women.

Loop Electrosurgical Excision Procedure

resources@acog.org — Thu, 17 Jan 2013 15:42:42 -0500

If you have an abnormal cervical cancer screening test result, your health care provider may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is used to remove the area containing abnormal cells from your cervix.

Managing High Blood Pressure

resources@acog.org — Thu, 17 Jan 2013 15:42:31 -0500

High blood pressure (or hypertension) has long been called a “silent killer” because it often causes no symptoms. After age 50 years, high blood pressure is more common in women than men. Untreated, high blood pressure can lead to other serious health conditions, such as heart disease, stroke, and kidney disease.

Midlife Transitions: Perimenopause to Menopause

resources@acog.org — Thu, 17 Jan 2013 15:42:19 -0500

Midlife—the stage of life between 40 years and 60 years—is an ongoing time of transition. For most women, the midlife years are a time of increased feelings of physical and emotional well-being. Midlife offers many women a greater sense of control over many parts of their lives. It may be a time for you to establish new goals beyond those of your youth and think about where to go next in your life. Maybe your children are older—even living on their own—giving you free time you have not had in years. You may switch to a new career, go back to school, become active in your community, or take up new hobbies.

Morning Sickness

resources@acog.org — Thu, 17 Jan 2013 15:42:06 -0500

Nausea and vomiting are common during pregnancy, especially during the first part of pregnancy. Although it is often called “morning sickness,” it can occur at any time of the day.

Newborn Circumcision

resources@acog.org — Thu, 17 Jan 2013 15:41:27 -0500

Circumcision is the surgical removal of the layer of skin, called the foreskin, that covers the glans (head) of the penis. Whether to have your son circumcised is your decision. If you choose this procedure for your baby, it usually is done soon after birth.

Nutrition During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:41:12 -0500

A balanced diet is a basic part of good health at all times in your life. During pregnancy, your diet is even more important. The foods you eat are the main source of nutrients for your baby. Healthy eating during pregnancy may take a little effort, but it will be a major benefit for you and your baby. If you have not been eating a healthy diet, pregnancy is a great time to change old habits and start healthy new ones.

Osteoporosis

resources@acog.org — Thu, 17 Jan 2013 15:40:57 -0500

Bones go through a constant state of loss and regrowth. As a person ages, more bone loss than bone growth occurs. This can lead to a condition called osteoporosis. The bones then become thin and fragile and can fracture or break easily.

Ovarian Cysts

resources@acog.org — Thu, 17 Jan 2013 15:40:46 -0500

The ovaries are two small organs located on either side of a woman's uterus. An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. It is normal for a small cyst to develop on the ovaries. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment.

Pain Relief During Labor and Delivery

resources@acog.org — Thu, 17 Jan 2013 15:40:33 -0500

Each woman's labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby and the strength of contractions.

Pelvic Inflammatory Disease

resources@acog.org — Thu, 17 Jan 2013 15:40:22 -0500

Pelvic inflammatory disease (PID) is an infection that affects the female reproductive organs. It is a common illness. PID is diagnosed in more than 1 million women each year in the United States.

Pelvic Support Problems

resources@acog.org — Thu, 17 Jan 2013 15:40:10 -0500

Almost one half of women who have had a baby have some degree of pelvic organ prolapse. Prolapse means "to drop" or "to sink." Pelvic support problems also can occur in women who have never had children. Most women with these problems have minor symptoms or no symptoms at all. For women with symptoms, proper diagnosis and treatment can bring relief.

Perimenopausal Bleeding and Bleeding After Menopause

resources@acog.org — Thu, 17 Jan 2013 15:39:58 -0500

During perimenopause, your periods may become less predictable. These changes are common. But some changes are not normal. Women with abnormal bleeding during perimenopause should see a health care provider. After menopause, you should not have any bleeding. A health care provider should always check bleeding that occurs after menopause.

Polycystic Ovary Syndrome

resources@acog.org — Thu, 17 Jan 2013 15:39:32 -0500

Polycystic ovary syndrome (PCOS) is a disorder that affects as many as 5–10% of women. PCOS has three key features: 1) high levels of hormones called androgens; 2) irregular menstrual periods or lack of periods; and (3) the presence of growths called cysts on the ovaries. Many women with PCOS have other signs and symptoms as well.

Postpartum Depression

resources@acog.org — Thu, 17 Jan 2013 15:39:19 -0500

Having a baby is a joyous time for most women. But many women feel sad, afraid, angry, or anxious after childbirth. Most new mothers have these feelings in a mild form called postpartum blues. Sometimes these feelings are called "baby blues." Postpartum blues almost always go away in a few days.

Preconception Carrier Screening

resources@acog.org — Thu, 17 Jan 2013 15:38:55 -0500

Before becoming pregnant, you may want to learn about your chances of having a child with a genetic disorder. This is called preconception carrier screening.

Pregnancy Choices Raising the Baby Adoption and Abortion

resources@acog.org — Thu, 17 Jan 2013 15:38:44 -0500

Some women have mixed feelings when they find out that they are pregnant. They may wonder if they are ready to accept and handle all that comes with raising a child. When you find out you are pregnant, you have a number of options. You can have and raise the baby. You can have the baby and place the baby for adoption or you can have an abortion (end the pregnancy).

Premenstrual Syndrome

resources@acog.org — Thu, 17 Jan 2013 15:38:31 -0500

Many women feel physical or mood changes during the days before menstruation. When these changes affect a woman's normal life, they are known as premenstrual syndrome (PMS).

Preparing for Surgery

resources@acog.org — Thu, 17 Jan 2013 15:38:17 -0500

If you are planning to have surgery, you will need to know some basic facts. Knowing what to expect before and after surgery and what questions to ask may help you feel less worried and more in control.

Preventing Deep Vein Thrombosis

resources@acog.org — Thu, 17 Jan 2013 15:37:51 -0500

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in deep veins in the legs or other areas of the body. DVT affects about 2 million people in the United States each year. Although anyone can develop DVT, women who have had major surgery, who have had trauma, or who are pregnant are at higher risk.

Problems of the Digestive System

resources@acog.org — Thu, 17 Jan 2013 15:37:36 -0500

Your digestive system breaks down foods that you eat and lets your body absorb nutrients. Your body needs nutrients to grow and produce energy. Problems in your digestive system can affect how your body uses nutrients. One of the more serious problems is colorectal cancer.

Protecting Yourself Against Hepatitis B and Hepatitis C

resources@acog.org — Thu, 17 Jan 2013 15:37:23 -0500

Hepatitis B and hepatitis C are serious infections that affect the liver. Both diseases are contagious and are caused by viruses. Both can lead to serious, long-term illness. Although some treatments are available, prevention is the best way to avoid the long-term consequences of both diseases. The best way to prevent hepatitis B infection is by getting the hepatitis B vaccine. Although there is no hepatitis C vaccine, the disease can be prevented by avoiding behavior that can pass the virus to others.

Reducing Your Risk of Birth Defects

resources@acog.org — Thu, 17 Jan 2013 15:37:08 -0500

Birth defects affect about 1 in 33 babies born in the United States each year. Some birth defects cannot be prevented. With others, there are steps you can take to reduce your risk of having a child with a certain defect. Prenatal tests also are available that check for or detect some birth defects.

Reducing Your Risk of Cancer

resources@acog.org — Thu, 17 Jan 2013 15:36:55 -0500

You can reduce your risk of getting cancer by adopting a healthy lifestyle, paying attention to how your body feels and looks, and having regular checkups. There are tests that can be done to find cancer early, when it can be more easily cured.

Routine Tests in Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:36:28 -0500

During pregnancy, all women have certain routine lab tests. These tests can help your doctor detect possible problems with your health and your baby's health. You also may have other tests, depending on your medical history, family or ethnic background, or previous test results.

Screening for Breast Problems

resources@acog.org — Thu, 17 Jan 2013 15:36:15 -0500

Most breast problems are minor, but some can be serious. The most serious, breast cancer, is a leading cause of cancer deaths in women.

Screening Tests for Birth Defects

resources@acog.org — Thu, 17 Jan 2013 15:36:04 -0500

Screening tests can give information about a pregnant woman's risk of having a baby with certain birth defects or genetic conditions. These tests also can help your doctor detect possible problems during your pregnancy. Some pregnant women may have other tests, depending on their medical histories, previous pregnancies, family or ethnic background, or exam results.

Seizure Disorders in Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:35:52 -0500

Seizure disorders are among the most common medical conditions that affect women. If you have a seizure disorder, you should be aware of the risks if you are thinking about becoming pregnant. It is important to work with your health care providers to get the special care you need both before and during pregnancy. Doing so may improve your chances of having a healthy pregnancy and a healthy baby.

Skin Conditions During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:35:40 -0500

Pregnancy changes a woman's body in many ways. Besides the change in weight, some of the most noticeable changes are those to the skin, hair, and nails. Many of these changes can cause anxiety because they can affect the way you look. However, most of them are harmless and will often go away after you give birth. When you start to notice the changes to your skin or nails, talk with your doctor. Your doctor can discuss the best ways to treat the conditions.

Sonohysterography

resources@acog.org — Thu, 17 Jan 2013 15:35:29 -0500

Sonohysterography is a technique in which a fluid is injected through the cervix into the uterus, and ultrasound is used to make images of the uterine cavity. The fluid shows more detail of the inside of the uterus than when ultrasound is used alone. The procedure can be done in a health care provider's office, hospital, or clinic. It usually takes about 15 minutes.

Special Tests for Monitoring Fetal Health

resources@acog.org — Thu, 17 Jan 2013 15:35:18 -0500

Special tests may be used to check the well-being of your unborn baby during pregnancy. These tests can help reassure you and your health care provider that all is going well. If problems arise, tests can help alert your health care provider that you or your baby may need special care.

Sterilization for Women and Men

resources@acog.org — Thu, 17 Jan 2013 15:34:52 -0500

Sterilization is a permanent method of birth control. It is the most popular form of birth control worldwide. Sterilization procedures for women are called tubal sterilization. The procedure for men is called vasectomy. Sterilization is a safe procedure with few complications.

Surgery for Stress Urinary Incontinence

resources@acog.org — Thu, 17 Jan 2013 15:34:40 -0500

Stress urinary incontinence is leakage of urine with physical activity, such as exercise, or when coughing, laughing, or sneezing. It is a common problem in women. Stress urinary incontinence can be treated with both nonsurgical and surgical treatment methods.

The Intrauterine Device

resources@acog.org — Thu, 17 Jan 2013 15:34:29 -0500

The intrauterine device (IUD) is one of the most effective forms of birth control. It is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy. The IUD can be used by women of all ages, including teenagers and those who have never had children.

The Menopause Years

resources@acog.org — Thu, 17 Jan 2013 15:34:17 -0500

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or “around menopause.” Menopause marks the end of the reproductive years that began in puberty.

The Rh Factor - How It Can Affect Your Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:34:06 -0500

During pregnancy, you will have a blood test to find out your blood type and whether your blood has the Rh factor. If your blood lacks the Rh factor, it is called Rh negative. If it has the Rh factor, it is called Rh positive. More people are Rh positive. Problems can arise when the fetus’s blood has the Rh factor and the mother’s blood does not. These problems can be prevented with early treatment.

Thyroid Disease

resources@acog.org — Thu, 17 Jan 2013 15:33:54 -0500

The thyroid is a gland that controls key functions of your body. Disease of the thyroid gland can affect nearly every organ in your body and harm your health. Thyroid disease is eight times more likely to occur in women than in men. In some women it occurs during or after pregnancy. In most cases, treatment of thyroid disease is safe and simple.

Tobacco Alcohol Drugs and Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:33:43 -0500

When you are pregnant, anything you eat, drink, or smoke can affect you and your baby. Alcohol and tobacco should not be used during pregnancy. It also is wise not to use any medication (over-the-counter or prescription) or herbal product without your doctor's advice.

Travel During Pregnancy

resources@acog.org — Thu, 17 Jan 2013 15:33:32 -0500

Traveling safely during pregnancy depends on whether you have any problems that need special care, how far along you are in your pregnancy, and your comfort. For most women, traveling is safe during pregnancy.

Ultrasound Exams

resources@acog.org — Thu, 17 Jan 2013 15:33:07 -0500

Ultrasound creates pictures of the internal organs of the body from sound waves. It is used to help find possible problems or to check a medical condition. During pregnancy, it can be used to examine the fetus.

Understanding Abnormal Pap Tests

resources@acog.org — Thu, 17 Jan 2013 15:32:55 -0500

The Pap test checks for changes in the cervix that may become cancer. If a Pap test shows these changes, the result is called abnormal. In women who have regular Pap tests, abnormal changes are almost always caught early. An abnormal Pap test result may mean that further testing and follow-up are needed.

Urinary Incontinence

resources@acog.org — Thu, 17 Jan 2013 15:32:43 -0500

Leakage of urine is called urinary incontinence. It is a common problem in women. Some women occasionally leak small amounts of urine. At other times, leakage of urine is frequent or severe. Often, women with this condition are too embarrassed to tell their health care providers about their symptoms. However, with proper diagnosis, urinary incontinence can most often be treated.

Uterine Fibroids

resources@acog.org — Thu, 17 Jan 2013 15:32:19 -0500

Uterine fibroids are benign (not cancer) growths in the uterus. They are the most common type of growth found in a woman's pelvis. In some women, fibroids remain small and do not cause symptoms or problems. However, in some women, fibroids can cause problems because of their size, number, and location.

Vaginitis

resources@acog.org — Thu, 17 Jan 2013 15:31:52 -0500

Vaginitis is an inflammation of a woman's vagina. It is one of the most common reasons why women see their health care providers. Vaginitis affects women of all ages. There are many possible causes of vaginitis, and the type of treatment depends on the cause.

Vulvodynia

resources@acog.org — Thu, 17 Jan 2013 15:31:40 -0500

Some women have chronic pain or discomfort in the vulva. This condition is called vulvodynia. No one really knows what causes vulvodynia, but there are treatments that can help relieve the pain.

What to Expect After Your Due Date

resources@acog.org — Thu, 17 Jan 2013 15:31:12 -0500

Waiting for the birth of a child can be both an exciting and anxious time, especially if your pregnancy extends past the due date. The average length of pregnancy is 280 days, or 40 weeks. Most women give birth between 38 weeks and 41 weeks of pregnancy. A pregnancy that lasts longer than 42 weeks is called “postterm.” About 6 out of 100 women give birth at 42 weeks or later.

When Sex is Painful

resources@acog.org — Thu, 17 Jan 2013 15:30:58 -0500

Pain during sexual intercourse is called dyspareunia. Pain that occurs during other sexual activities is called noncoital sexual pain disorder. Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem. Painful intercourse has many possible causes. Successful treatment depends on finding the right cause and sometimes trying different treatment options.

Your Sexual Health

resources@acog.org — Thu, 17 Jan 2013 14:42:25 -0500

Sex is a normal, healthy part of life. But many women have problems with sex at some point in their lives. If you are having a problem with sex, and it is worrying or upsetting you, you may want to find a solution. Some sexual problems can be solved by you alone or with your partner. For others, you may want to see a health care provider.

Your First Period - Especially for Teens

resources@acog.org — Thu, 17 Jan 2013 14:42:01 -0500

Puberty is a time when your body begins to change to become more like an adult’s. Starting your menstrual period is one of these changes. Getting your first period means that you are growing up and becoming a young woman. You may be looking forward to getting your first period, or you may feel like these changes are happening before you are ready for them. Knowing about the changes in your body can help you feel healthy and more in control.

Your First Gynecologic Visit - Especially for Teens

resources@acog.org — Thu, 17 Jan 2013 14:41:42 -0500

Part of growing up is learning to take care of your body. This means making good choices for your health, avoiding things that can hurt you, and seeing a health care provider—including an obstetrician–gynecologist (ob–gyn)—for routine health care. If you have never visited an ob-gyn before, you may have questions about what will happen at your first visit.

Your Changing Body - Especially for Teens

resources@acog.org — Thu, 17 Jan 2013 14:41:20 -0500

Puberty is a time when your body changes—inside and out. Your body is becoming more like an adult. You may have questions about your changing body. This pamphlet may help answer some of those questions. You also can ask a parent, a doctor, a teacher, or another adult you trust.

The Obstetrician-Gynecologist Workforce in the United States

Thu, 17 Jan 2013 12:40:14 -0500

http://www.acog.org/~/media/The%20Ob-Gyn%20Workforce/Members%20Only/obgynWorkforce.pdf

The Obstetrician–Gynecologist Distribution Atlas

Thu, 17 Jan 2013 12:39:43 -0500

http://www.acog.org/~/media/The%20Ob-Gyn%20Workforce/Members%20Only/obgynAtlas.pdf

The Ob-Gyn Workforce

Thu, 17 Jan 2013 12:25:45 -0500

Gynecologic Care for Women With Human Immunodeficiency Virus

resources@acog.org — Thu, 20 Dec 2012 16:10:22 -0500

The increased use of screening tests has led to the identification of large numbers of women with human immunodeficiency virus (HIV). Consequently, there is an increased role for obstetrician–gynecologists in caring for infected women. Women infected with HIV are living longer, healthier lives and, therefore, the need for routine gynecologic care has increased. The purpose of this document is to educate clinicians about routine HIV screening practices as well as basic women's health screening and care, family planning, and preconception care for women who are infected with HIV.

Alternatives to Hysterectomy in the Management of Leiomyomas

resources@acog.org — Thu, 20 Dec 2012 16:08:54 -0500

Uterine leiomyomas (also called fibroids) are the most common solid pelvic tumors in women and the leading indication for hysterectomy. Although many women with uterine leiomyomas are asymptomatic and can be monitored without treatment, some will require more active measures. Hysterectomy remains the most common surgical treatment for leiomyomas because it is the only definitive treatment and eliminates the possibility of recurrence. Many women seek an alternative to hysterectomy because they desire future childbearing or wish to retain their uteri even if they have completed childbearing. As alternatives to hysterectomy become increasingly available, the efficacies and risks of these treatments are important to delineate. The purpose of this bulletin is to review the literature about medical and surgical alternatives to hysterectomy and to offer treatment recommendations.

Medical Management of Ectopic Pregnancy

resources@acog.org — Thu, 20 Dec 2012 16:06:06 -0500

In the United States, ectopic pregnancy accounts for 2% of all first-trimester pregnancies and 6% of all pregnancy-related deaths; it is the leading cause of maternal death in the first trimester (1). Early detection of ectopic pregnancy can lead to successful management without surgery. Methotrexate, a folic acid antagonist, can be used successfully to treat early, nonruptured ectopic pregnancy. The purpose of this document is to review the risks and benefits of the use of methotrexate in the management of ectopic pregnancy.

Use of Psychiatric Medications During Pregnancy and Lactation

resources@acog.org — Thu, 20 Dec 2012 16:03:18 -0500

It is estimated that more than 500,000 pregnancies in the United States each year involve women who have psychiatric illnesses that either predate or emerge during pregnancy, and an estimated one third of all pregnant women are exposed to a psychotropic medication at some point during pregnancy (1). The use of psychotropic medications is a cause of concern for physicians and their patients because of the potential teratogenic risk, the risk of perinatal syndromes or neonatal toxicity, and the risk for abnormal postnatal behavioral development. With the limited information available on the risks of the psychotropic medications, clinical management must incorporate an appraisal of the clinical consequences of offspring exposure, the potential effect of untreated maternal psychiatric illness, and the available alternative therapies. The purpose of this document is to present current evidence on the risks and benefits of treatment for certain psychiatric illnesses during pregnancy.

Asthma in Pregnancy

resources@acog.org — Thu, 20 Dec 2012 16:01:30 -0500

Asthma is a common, potentially serious medical condition that complicates approximately 4–8% of pregnancies (1, 2). In general, the prevalence of and morbidity from asthma are increasing, although asthma mortality rates have decreased in recent years. The purpose of this document is to review the best available evidence about the management of asthma during pregnancy.

Viral Hepatitis in Pregnancy

resources@acog.org — Thu, 20 Dec 2012 15:58:12 -0500

Viral hepatitis is one of the most common and potentially serious infections that can occur in pregnant women. Six forms of viral hepatitis have now been identified, two of which, hepatitis A and hepatitis B, can be prevented effectively through vaccination. The purpose of this document is to describe the specific subtypes of hepatitis, their implications during pregnancy, the risk of perinatal transmission, and issues related to both treatment and prevention of infection.

Management of Herpes in Pregnancy

resources@acog.org — Thu, 20 Dec 2012 15:56:02 -0500

Genital herpes simplex virus (HSV) infection during pregnancy poses a risk to the developing fetus and newborn. Genital herpes infection occurs in one in five women in the United States. Because many women of childbearing age are infected or are becoming infected with HSV, the risk of maternal transmission of this virus to the fetus or newborn is a major health concern. The purpose of this document is to outline the spectrum of maternal and neonatal infection, including risks of transmission, and provide management guidelines supported by appropriately conducted outcome-based research. Additional guidelines based on consensus and expert opinion also are presented to permit a review of most clinical aspects of HSV.

Management of Alloimmunization During Pregnancy

resources@acog.org — Thu, 20 Dec 2012 15:55:40 -0500

When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal–maternal bleeding may stimulate an immune reaction in the mother. Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or "alloimmunization," may lead to various degrees of transplacental passage of these antibodies into the fetal circulation. Depending on the degree of antigenicity and the amount and type of antibodies involved, this transplacental passage may lead to hemolytic disease in the fetus and neonate. Undiagnosed and untreated, alloimmunization can lead to significant perinatal morbidity and mortality. Advances in Doppler ultrasonography have led to the development of noninvasive methods of management of alloimmunization in pregnant women. Together with more established protocols, Doppler ultrasound evaluation may allow for a more thorough and less invasive workup with fewer risks to the mother and fetus. Prevention of alloimmunization is addressed in another Practice Bulletin (1).

Pregestational Diabetes Mellitus

resources@acog.org — Thu, 20 Dec 2012 15:52:54 -0500

Pregestational diabetes mellitus represents one of the most challenging medical complications of pregnancy. This document provides an overview of the current understanding of pregestational diabetes mellitus and suggests management guidelines during pregnancy. Because few well-designed studies have been performed, many of the guidelines are based on expert and consensus opinion.

Diagnosis and Treatment of Gestational Trophoblastic Disease

resources@acog.org — Thu, 20 Dec 2012 15:47:49 -0500

Gestational trophoblastic disease comprises a spectrum of interrelated conditions originating from the placenta. Other terms often used to refer to these conditions include gestational trophoblastic neoplasia and gestational trophoblastic tumor. Histologically distinct disease entities encompassed by this general terminology include complete and partial hydatidiform moles, invasive moles, gestational choriocarcinomas, and placental site trophoblastic tumors. Before the advent of sensitive assays for human chorionic gonadotropin (hCG) and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial. At present, with sensitive quantitative assays for ß-hCG and current approaches to chemotherapy, most women with malignant gestational trophoblastic disease can be cured and their reproductive function preserved. The purpose of this document is to address current evidence regarding the diagnosis, staging, and management of gestational trophoblastic disease.

Perinatal Care at the Threshold of Viability

resources@acog.org — Thu, 20 Dec 2012 15:43:49 -0500

The survival rate for extremely preterm or extremely low-birth-weight (LBW) newborns born at the threshold of viability (25 or fewer completed weeks of gestation) improved in the early 1990s, largely as the result of a greater use of assisted ventilation in the delivery room and surfactant therapy. Increased use of antenatal and neonatal corticosteroids also may have influenced survival rates (1–4). However, this improvement in survival has not been associated with an equal improvement in morbidity. The incidence of chronic lung disease, sepsis, and poor growth remains high and may even have increased. There is concern that the treatment of extremely preterm and extremely LBW newborns may result in unforeseen effects into adulthood (4, 5), and that the neurodevelopmental outcome and cognitive function of extremely preterm and extremely LBW infants may be suboptimal (6–8). The purpose of this document is to describe the potential consequences of extremely preterm birth and to provide clinical management guidelines based on the best available data.

Aromatase Inhibitors in Gynecologic Practice

resources@acog.org — Thu, 20 Dec 2012 15:41:04 -0500

ABSTRACT: Aromatase inhibitors appear to be effective as an adjuvant treatment for early-stage and late-stage breast cancer. Their role in chemoprevention of breast cancer in high-risk patients remains to be defined. Side effects of aromatase inhibitors in postmenopausal women are due to estrogen-lowering action at the target tissues and include hot flushes, vaginal dryness, arthralgias, and decreased bone mineral density. In reproductive-aged women, aromatase inhibitors stimulate gonadotropin secretion and increase ovarian follicular activity. The role of aromatase inhibitors in the treatment of endometriosis and in ovulation induction is still being investigated.

Elective Coincidental Appendectomy

resources@acog.org — Thu, 20 Dec 2012 15:39:07 -0500

ABSTRACT: Because of a lack of evidence from randomized trials, it remains unclear whether the benefits of routine elective coincidental appendectomy outweigh the cost and risk of morbidity associated with this prophylactic procedure. Because the risk–benefit analysis varies according to patient age and history, the decision to perform an elective coincidental appendectomy at the time of an unrelated gynecologic surgical procedure should be based on individual clinical scenarios and patient characteristics and preferences.

The Importance of Preconception Care in the Continuum of Women's Health Care

resources@acog.org — Thu, 20 Dec 2012 15:37:05 -0500

ABSTRACT: The goal of preconception care is to reduce the risk of adverse health effects for the woman, fetus, or neonate by optimizing the woman's health and knowledge before planning and conceiving a pregnancy. Because reproductive capacity spans almost four decades for most women, optimizing women's health before and between pregnancies is an ongoing process that requires access to and the full participation of all segments of the health care system.

Preoperative Planned Cesarean Delivery

resources@acog.org — Thu, 29 Nov 2012 11:21:59 -0500

The Patient Safety Checklist on Preoperative Planned Cesarean Delivery should be completed by the health care provider during the patient's admission.

Magnesium Sulfate before Anticipated Preterm Birth for Neuroprotection

resources@acog.org — Thu, 29 Nov 2012 11:21:38 -0500

The Patient Safety Checklist on Magnesium Sulfate before Anticipated Preterm Birth for Neuroprotection should be completed by the health care provider during the patient's admission.

Documenting Shoulder Dystocia

resources@acog.org — Thu, 29 Nov 2012 11:16:06 -0500

The Patient Safety Checklist on Documenting Shoulder Dystocia should be used to guide the documentation process if a patient has experienced shoulder dystocia.

Trial of Labor After Previous Cesarean Delivery (Intrapartum Admission)

resources@acog.org — Thu, 29 Nov 2012 11:14:28 -0500

The Patient Safety Checklist on Trial of Labor After Previous Cesarean Delivery should be completed by the health care provider when a patient who is undergoing a trial of labor after a previous cesarean delivery is admitted to Labor and Delivery.

Appropriateness of Trial of Labor after Previous Cesarean Delivery (Antepartum Period)

resources@acog.org — Thu, 29 Nov 2012 11:12:23 -0500

The Patient Safety Checklist on Appropriateness of Trial of Labor After Previous Cesarean Delivery should be completed by the health care provider early in the course of prenatal care for patients for whom a trial of labor after a previous cesarean delivery may be appropriate.

Scheduling Planned Cesarean Delivery

resources@acog.org — Thu, 29 Nov 2012 11:10:05 -0500

The Patient Safety Checklist on Scheduling Planned Cesarean Delivery should be completed by the health care provider and submitted to the respective hospital to schedule a planned cesarean delivery. The hospital should establish procedures to review the appropriateness of the scheduling based on the information contained in the checklist. A hard stop should be called if there are questions that arise that require further information or consultation with the department chair.

Inpatient Induction of Labor

resources@acog.org — Thu, 29 Nov 2012 11:07:53 -0500

The Patient Safety Checklist on Inpatient Induction of Labor should be completed by the health care provider at the time of the patient’s admission.

Scheduling Induction of Labor

resources@acog.org — Thu, 29 Nov 2012 11:03:33 -0500

The Patient Safety Checklist on Scheduling Induction of Labor should be completed by the health care provider and submitted to the respective hospital to schedule an induction of labor. The hospital should establish procedures to review the appropriateness of the scheduling based on the information contained in the checklist. A hard stop should be called if there are questions that arise that require further information or consultation with the department chair.

The Initial Reproductive Health Visit

resources@acog.org — Fri, 16 Nov 2012 13:05:58 -0500

ABSTRACT: The American College of Obstetricians and Gynecologists recommends that the first dedicated reproductive health visit take place between the ages of 13 years and 15 years. This visit will provide health guidance, screening, and preventive health care services and offers an excellent opportunity to begin a physician–patient relationship. This visit does not generally include an internal pelvic examination.

Human Papillomavirus Vaccination

resources@acog.org — Fri, 16 Nov 2012 13:05:47 -0500

ABSTRACT: The U.S. Food and Drug Administration has approved both a bivalent and quadrivalent human papillomavirus (HPV) vaccine. The Advisory Committee on Immunization Practices has recommended that HPV vaccination routinely be given to girls when they are 11 years or 12 years old. The vaccine can be given to individuals as young as 9 years; catch-up vaccination is recommended in females aged 13 years through 26 years. The American College of Obstetricians and Gynecologists endorses these recommendations. Although obstetrician–gynecologists are not likely to care for many girls in the initial vaccination target group, they are critical to the catch-up vaccination period. Both HPV vaccines are most effective if given before any exposure to HPV infection (ie, before sexual activity). However, sexually active girls and women can receive some benefit from the vaccination because exposure to all HPV types prevented by the vaccines is unlikely in females aged 13 years through 26 years. Vaccination with either HPV vaccine is not recommended for pregnant women. It can be provided to women who are breastfeeding. The need for booster vaccination has not been established but appears unnecessary. Health care providers are encouraged to discuss with their patients the benefits and limitations of the HPV vaccine and the need for routine cervical cytology screening for those aged 21 years and older.

Expedited Partner Therapy in the Management of Gonorrhea and Chlamydia by Obstetrician-Gynecologists

resources@acog.org — Fri, 16 Nov 2012 13:05:42 -0500

ABSTRACT: Expedited partner therapy is the clinical practice of treating the sex partners of patients, in whom sexually transmitted infections are diagnosed, by providing prescriptions or medications to the patient to take to his or her partner(s) without the health care provider first examining the partner(s). The American College of Obstetricians and Gynecologists supports expedited partner therapy in the management of gonorrhea and chlamydial infections when the partner is unlikely or unable to otherwise receive in-person evaluation and appropriate treatment. The legality of expedited partner therapy is ambiguous in some states and overt legal impediments exist in others; analysis suggests that the practice is permissible in 27 states. Clinicians practicing in states where expedited partner therapy is legal should use it for eligible patients. In states, territories, and other jurisdictions where expedited partner therapy is not legal or the legal status of expedited partner therapy is unclear or ambiguous, clinicians are encouraged to advocate for its legality and implementation and work with their health departments to develop protocols for the use of expedited partner therapy. All health care providers should advocate for greater availability of sexually transmitted infection services.

Cervical Cancer in Adolescents - Screening Evaluation and Management

resources@acog.org — Fri, 16 Nov 2012 13:05:33 -0500

ABSTRACT: Based on several recent studies, new guidelines for initiation of cervical cancer screening have been developed. Evidence shows that screening before the age of 21 years does not change the rate of cervical cancer in that age group or in older women. Cervical cancer, in general, is extremely rare in those younger than 21 years. Consequently, cervical cancer screening should begin at age 21 years. If cytology is performed before age 21 years, it is important to recognize that the management of cervical cytologic abnormalities in adolescents differs from that of the adult population. The publication of the American Society of Colposcopy and Cervical Pathology 2006 consensus guidelines has led to major changes in the management of cervical disease in adolescents, which emphasize minimal to no intervention. These guidelines advise against human papillomavirus testing and recommend observation for the management of cervical intraepithelial neoplasia 1 in adolescents. In addition, observation is preferred for the management of cervical intraepithelial neoplasia 2. The guidelines were established to minimize the potential negative effect that screening can cause, unnecessary referrals for colposcopy, and the negative effect that treatment can have on future pregnancy outcomes.

Inappropriate Reimbursement Practices by Third-Party Payers

resources@acog.org — Fri, 16 Nov 2012 13:05:05 -0500

ABSTRACT: The American College of Obstetricians and Gynecologists (ACOG) Committee on Coding and Nomenclature believes that physicians must code accurately the services they provide and the diagnoses that justify those services for purposes of appropriate payment.

Professional Responsibilities in Obstetric-Gynecologic Medical Education and Training

resources@acog.org — Fri, 16 Nov 2012 13:03:34 -0500

ABSTRACT: The education of health care professionals is essential to maintaining standards of medical competence and access to care by patients. Inherent in the education of health care professionals is the problem of disparity in power and authority, including the power of teachers over learners and the power of practitioners over patients. Although there is a continuum of supervision levels and independence from student to resident to fellow, the ethical issues that arise during interactions among all teachers, learners, and their patients are similar. In this Committee Opinion, the Committee on Ethics of the American College of Obstetricians and Gynecologists discusses and offers recommendations regarding the professional conduct and ethical responsibilities of practitioners toward patients and participants in research in educational settings; of learners and teachers toward one another; and of institutions toward patients, learners, and teachers.

Maternal-Fetal Intervention and Fetal Care Centers

resources@acog.org — Fri, 16 Nov 2012 13:03:13 -0500

ABSTRACT: The past two decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics make recommendations regarding informed consent, the role of research subject advocates and other independent advocates, the availability of support services, the multidisciplinary nature of fetal intervention teams, the oversight of centers, and the need to accumulate maternal and fetal outcome data.

Forming a Just Health Care System

resources@acog.org — Fri, 16 Nov 2012 13:02:54 -0500

ABSTRACT: In this Committee Opinion, the Committee on Ethics of the American College of Obstetricians and Gynecologists endorses the College's ongoing efforts to promote a just health care system, explores justifications that inform just health care, and identifies professional responsibilities to guide the College and its members in advancing the cause of health care reform.

Ethical Ways for Physicians to Market a Practice

resources@acog.org — Fri, 16 Nov 2012 13:02:44 -0500

ABSTRACT: It is ethical for physicians to market their practices provided that the communication is truthful and not misleading, deceptive, or discriminatory. All paid advertising must be clearly identified as such. Producing fair and accurate advertising of medical practices and services can be challenging. It often is difficult to include detailed information because of cost and size restrictions or the limitations of the media form that has been selected. If the specific advertising form does not lend itself to clear and accurate description, an alternative media format should be selected. Advertising that seeks to denigrate the competence of other individual professionals or group practices is always unethical.

Ethical Considerations for Performing Gynecologic Surgery in Low-Resource Settings Abroad

resources@acog.org — Fri, 16 Nov 2012 13:02:34 -0500

ABSTRACT: International humanitarian medical efforts provide essential services to patients who would not otherwise have access to specific health care services. The Committees on Ethics and Global Women's Health of the American College of Obstetricians and Gynecologists encourage College Fellows and other health care professionals to participate in international humanitarian medical efforts for this reason. However, such programs present Fellows with a unique set of practical and ethical challenges. It is important for health care providers to consider these challenges before participating in international surgical efforts in these settings. Health care professionals should ensure that they have the necessary surgical competence and training, including sufficient mentorship, prior to functioning as the primary surgeon abroad. Before they perform surgery, health care professionals should ensure that patients have access to adequate medical resources and preoperative and postoperative care. They should be willing and prepared to postpone or cancel surgery when the standards of ethical medical care cannot be met and the members of the surgical team believe that the best interest of the patient cannot be achieved with the current available resources. Health care professionals' efforts should contribute to the long-term well-being of the patients and the communities being served through the ethical practice of medicine, responsible conduct of research, and investment in the sustainability of services. The care of the patient should be the highest priority for those participating in these medical programs.

Empathy in Womens Health Care

resources@acog.org — Fri, 16 Nov 2012 13:02:26 -0500

ABSTRACT: Empathy is the process through which one attempts to project oneself into another's life and imagine a situation from his or her point of view. Most individuals do have an innate capacity to show empathy toward others. Empathy is as important to being a good physician as technical competence. However, at times the health care environment and educational process overly emphasize technological competence, curing disease rather than healing the patient, or the economic aspects of medicine. This may interfere with an empathic approach in the clinical setting. In this Committee Opinion, the Committee on Ethics of the American College of Obstetricians and Gynecologists defines empathy and related terms, describes the role of empathy in medicine, outlines objections and barriers to incorporating empathy into clinical care, reviews research on measuring empathy, discusses the inclusion of empathy in medical education, and makes recommendations about empathic care for health care providers and the health care system.

Update on Carrier Screening for Cystic Fibrosis

resources@acog.org — Fri, 16 Nov 2012 13:01:46 -0500

ABSTRACT: In 2001, the American College of Obstetricians and Gynecologists and the American College of Medical Genetics introduced guidelines for prenatal and preconception carrier screening for cystic fibrosis. The American College of Obstetricians and Gynecologists' Committee on Genetics has updated current guidelines for cystic fibrosis screening practices among obstetrician–gynecologists.

Pharmacogenetics

resources@acog.org — Fri, 16 Nov 2012 13:01:31 -0500

ABSTRACT: Pharmacogenetics is the study of genetic variations in drug response that are determined by specific genes. It is hoped that the use of pharmacogenetics in clinical practice may improve drug safety and decrease the rate of adverse drug reactions. Given the potential applications of pharmacogenetics to women's health care, obstetricians and gynecologists should be aware of this rapidly developing field. Currently, however, there are limited clinical indications for the use of pharmacogenetics in routine obstetric and gynecologic practice.

Newborn Screening

resources@acog.org — Fri, 16 Nov 2012 13:01:19 -0500

ABSTRACT: Newborn screening programs are mandatory, state-based public health programs. They provide newborns in the United States with presymptomatic testing and necessary follow-up care for a variety of medical conditions for which early intervention will improve neonatal and long-term health outcomes for the individual. Although current state requirements vary, the results of surveys and focus groups of expectant parents demonstrate that women and their families would like to receive information about newborn screening during their prenatal care. The Committee on Genetics recommends that obstetric care providers make resources regarding newborn screening available to patients through informational brochures, electronic sources, or through discussion during prenatal visits.

Family History as a Risk Assessment Tool

resources@acog.org — Fri, 16 Nov 2012 13:01:10 -0500

ABSTRACT: Family history plays a critical role in assessing the risk of inherited medical conditions and single gene disorders. Several methods have been established to obtain family medical histories, including the family history questionnaire or checklist and the pedigree. The screening tool selected should be tailored to the practice setting and patient population. It is recommended that all women receive a family history evaluation as a screening tool for inherited risk. Family history information should be reviewed and updated regularly, especially when there are significant changes to family history. Where appropriate, further evaluation should be considered for positive responses, with referral to genetic testing and counseling as needed.

Carrier Screening for Fragile X Syndrome

resources@acog.org — Fri, 16 Nov 2012 13:01:01 -0500

ABSTRACT: Fragile X syndrome is the most common inherited form of mental retardation. The syndrome occurs in approximately 1 in 3,600 males and 1 in 4,000–6,000 females. Approximately 1 in 250 females carry the premutation. DNA-based molecular analysis is the preferred method of diagnosis for fragile X syndrome and its premutations. Prenatal testing for fragile X syndrome should be offered to known carriers of the fragile X premutation or full mutation. Women with a family history of fragile X-related disorders, unexplained mental retardation or developmental delay, autism, or premature ovarian insufficiency are candidates for genetic counseling and fragile X premutation carrier screening.

Colonoscopy and Colorectal Cancer Screening Strategies

resources@acog.org — Fri, 16 Nov 2012 13:00:41 -0500

ABSTRACT: Each year colorectal cancer is diagnosed in more women than all types of gynecologic cancer combined. There continues to be a significant need to increase the rate of screening. Obstetrician–gynecologists have a unique opportunity to increase colorectal cancer screening rates among their patients and, thus, favorably affect colorectal cancer morbidity and mortality. Health care providers should counsel patients about the benefits of colorectal cancer screening and recommend colonoscopy every 10 years for either average-risk or high-risk women 50 years and older. The advantages and limitations of other appropriate colorectal cancer screening methods also should be discussed so that women may choose to be tested by whichever method they are most likely to accept and complete.

Compounded Bioidentical Menopausal Hormone Therapy

resources@acog.org — Fri, 16 Nov 2012 13:00:35 -0500

ABSTRACT: Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effectiveness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an individualized preparation in response to a health care provider’s prescription to create a medication tailored to the specialized needs of an individual patient. The Women’s Health Initiative findings, coupled with an increase in the direct-to-consumer marketing and media promotion of compounded bioidentical hormonal preparations as safe and effective alternatives to conventional menopausal hormone therapy, have led to a recent increase in the popularity of compounded bioidentical hormones as well as an increase in questions about the use of these preparations. Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over conventional menopausal hormone therapy, but these claims also pose the additional risks of variable purity and potency and lack efficacy and safety data. The Committee on Gynecologic Practice of the American College of Obstetricians and Gynecologists and the Practice Committee of the American Society for Reproductive Medicine provide an overview of the major issues of concern surrounding compounded bioidentical menopausal hormone therapy and provide recommendations for patient counseling.

Hepatitis B Hepatitis C and Human Immunodeficiency Virus Infections in Obstetrician - Gynecologists

resources@acog.org — Fri, 16 Nov 2012 13:00:27 -0500

ABSTRACT: In the health care setting, bloodborne pathogens such as the hepatitis B virus (HBV), hepatitis C virus, and human immunodeficiency virus (HIV) may be transmitted from infected patients to health care workers as well as from infected health care workers to patients. To reduce the risk of transmission, all practicing obstetrician–gynecologists should receive the HBV vaccine. Obstetrician–gynecologists infected with HBV, hepatitis C virus, or HIV are advised to follow the updated Society for Healthcare Epidemiology of America's recommendations, regarding infection-control measures, supervision, and periodic testing. These recommendations provide a framework within which to consider such cases; however, each case should be independently considered in context by the expert review panel.

Management of Vulvar Intraepithelial Neoplasia

resources@acog.org — Fri, 16 Nov 2012 13:00:09 -0500

ABSTRACT: Vulvar intraepithelial neoplasia (VIN) is an increasingly common problem, particularly among women in their 40s. The term VIN is used to denote high-grade squamous lesions and is subdivided into usual-type VIN (including warty, basaloid, and mixed VIN) and differentiated VIN. Usual-type VIN is commonly associated with carcinogenic genotypes of human papillomavirus (HPV) and other HPV persistence risk factors, such as cigarette smoking and immunocompromised status, whereas differentiated VIN usually is not associated with HPV and is more often associated with vulvar dermatologic conditions, such as lichen sclerosus. Biopsy is indicated for any pigmented vulvar lesion. Treatment is indicated for all cases of VIN. When occult invasion is not a concern, VIN can be treated with surgical therapy, laser ablation, or medical therapy. After resolution, women should be monitored at 6 and 12 months and annually thereafter.

Performance Enhancing Anabolic Steroid Abuse in Women

resources@acog.org — Fri, 16 Nov 2012 12:59:57 -0500

ABSTRACT: Anabolic steroids are composed of testosterone and other substances related to testosterone that promote growth of skeletal muscle, increase hemoglobin concentration, and mediate secondary sexual characteristics. These substances have been in use since the 1930s to promote muscle growth, improve athletic performance, and enhance cosmetic appearance. Although anabolic steroids are controlled substances, only to be prescribed by a physician, it is currently possible to obtain anabolic steroids illegally without a prescription. There are significant negative physical and psychologic effects of anabolic steroid use, which in women can cause significant cosmetic and reproductive changes. Anabolic steroid use can be addictive and, therefore, difficult to stop. Treatment for anabolic steroid abuse generally involves education, counseling, and management of withdrawal symptoms. Health care providers are encouraged to address the use of these substances, encourage cessation, and refer patients to substance abuse treatment centers to prevent the long-term irreversible consequences of anabolic steroid use.

The Role of the Obstetrician Gynecologist in the Early Detection of Epithelial Ovarian Cancer

resources@acog.org — Fri, 16 Nov 2012 12:59:28 -0500

ABSTRACT: Epithelial ovarian cancer is most commonly detected in an advanced stage, when the overall 5-year survival rate is 20–30%. Detection of early-stage ovarian cancer results in improved survival. Currently, there is no effective strategy for ovarian cancer screening. Women with persistent and progressive symptoms, such as an increase in bloating, pelvic or abdominal pain, or difficulty eating or feeling full quickly, should be evaluated, with ovarian cancer being included in the differential diagnosis. Evaluation of the symptomatic patient includes physical examination and may include transvaginal ultrasonography and measurement of levels of the serum tumor marker CA 125. Patients suspected of having ovarian cancer should be managed by a gynecologic surgeon, such as a gynecologic oncologist, who is trained to perform comprehensive surgical staging and cytoreductive (debulking) surgery.

Understanding and Using the US Medical Eligibility Criteria for Contraceptive Use, 2010

resources@acog.org — Fri, 16 Nov 2012 12:59:19 -0500

ABSTRACT: The 2010 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) issued by the Centers for Disease Control and Prevention gives comprehensive, evidence-based guidance to clinicians providing family planning services to women, especially women with medical conditions. The American College of Obstetricians and Gynecologists endorses the U.S. MEC and encourages its use by Fellows.

Use of Hysterosalpingography After Tubal Sterilization

resources@acog.org — Fri, 16 Nov 2012 12:57:20 -0500

ABSTRACT: The U.S. Food and Drug Administration has approved two devices for hysteroscopic tubal sterilization. To minimize the failure rates of these effective methods, it is important for health care providers to understand the important role hysterosalpingography (HSG) plays in any hysteroscopic tubal sterilization procedure. The purpose of this Committee Opinion is to emphasize the necessity of performing HSG 3 months after hysteroscopic tubal sterilization and to identify factors that may interfere with performance of an adequate HSG assessment.

Vaginal Placement of Synthetic Mesh for Pelvic Organ Prolapse

resources@acog.org — Fri, 16 Nov 2012 12:57:13 -0500

ABSTRACT: Since 2004, use of synthetic mesh has increased in vaginal surgery for the treatment of pelvic organ prolapse. However, concerns exist about the safety and efficacy of transvaginally placed mesh. Based on the currently available limited data, although many patients undergoing mesh-augmented vaginal repairs heal well without problems, there seems to be a small but significant group of patients who experience permanent and life-altering sequelae, including pain and dyspareunia, from the use of vaginal mesh. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society provide background information on the use of vaginally placed mesh for the treatment of pelvic organ prolapse and offer recommendations for practice.

Tobacco Use and Women's Health

resources@acog.org — Fri, 16 Nov 2012 12:55:04 -0500

ABSTRACT: Tobacco use negatively affects every organ system and is the most prevalent cause of premature death for adults within the United States. Compared with women who are nonsmokers, women who smoke cigarettes have greater risks of reproductive health problems, many forms of gynecologic cancer and other types of cancer, coronary and vascular disease, chronic obstructive lung disease, and osteoporosis. Brief behavioral counseling and the use of evidence-based smoking cessation aids are effective strategies for achieving smoking cessation even for very heavy smokers. The trained obstetrician–gynecologist is well positioned to screen and counsel all patients on tobacco use and to advocate for smoke-free environments. Smoking cessation counseling is often reimbursed by health insurers. Tobacco use has deleterious effects on women through all stages of life. Tools are available for obstetrician–gynecologists to screen for and treat tobacco abuse and give the appropriate coding for smoking cessation counseling.

Substance Abuse Reporting and Pregnancy The Role of the Obstetrician Gynecologist

resources@acog.org — Fri, 16 Nov 2012 12:54:56 -0500

ABSTRACT: Drug enforcement policies that deter women from seeking prenatal care are contrary to the welfare of the mother and fetus. Incarceration and the threat of incarceration have proved to be ineffective in reducing the incidence of alcohol or drug abuse. Obstetrician–gynecologists should be aware of the reporting requirements related to alcohol and drug abuse within their states. They are encouraged to work with state legislators to retract legislation that punishes women for substance abuse during pregnancy.

Smoking Cessation During Pregnancy

resources@acog.org — Fri, 16 Nov 2012 12:54:50 -0500

ABSTRACT: Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. The physical and psychologic addiction to cigarettes is powerful; however, the compassionate intervention of the obstetrician–gynecologist can be the critical element in prenatal smoking cessation. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment or referral has been proved to increase quit rates. A short counseling session with pregnancy-specific educational materials and a referral to the smokers' quit line is an effective smoking cessation strategy. The 5A's is an office-based intervention developed to be used under the guidance of trained practitioners to help pregnant women quit smoking. Knowledge of the use of the 5A's, health care support systems, and pharmacotherapy add to the techniques providers can use to support perinatal smoking cessation.

Sexual Assault

resources@acog.org — Fri, 16 Nov 2012 12:54:21 -0500

ABSTRACT: Victims of sexual assault who are of reproductive age are at risk of unintended pregnancy as well as sexually transmitted diseases. Therefore, emergency contraception and prophylaxis for sexually transmitted diseases should be available and provided to these women. Sexual assault victims are also at risk of mental health conditions such as posttraumatic stress disorder. Health care providers should screen routinely for a history of sexual assault. The physician who examines victims of sexual assault has a responsibility to be aware of state and local statutory or policy requirements that may involve the use of assessment kits for gathering evidence.

Preparing for Disasters: Perspectives on Women

resources@acog.org — Fri, 16 Nov 2012 12:54:04 -0500

ABSTRACT: Emergency plans that specifically address the needs of women, infants, and children during disasters are currently underdeveloped in the United States. Pregnant women, infants, and children are adversely affected by disasters resulting in an increased number of infants with intrauterine growth restriction, low birth weight, and a small head circumference. There is an increased incidence of preterm delivery. To provide for a healthy pregnancy and delivery, pregnant women affected by disasters need to be assured of a continuation of prenatal care. Those in the third trimester should be aware of established local health care facilities that can provide prenatal care and obstetric services during a disaster. Establishing and maintaining lactation before, during, and after a disaster is important for infant nutrition. Decreasing the number of unintended pregnancies can be achieved by providing both prophylactic and emergency contraception. Women involved in disasters are also at an increased risk for sexual assault and should be provided a safe and secure environment in evacuation shelters. In addition to emergency contraception, sexual assault forensic examiners or sexual assault nurse examiners should be available for victims of sexual assault.

Opioid Abuse, Dependence, and Addiction in Pregnancy

resources@acog.org — Fri, 16 Nov 2012 12:53:53 -0500

ABSTRACT: Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. During the intrapartum and postpartum period, special considerations are needed for women who are opioid dependent to ensure appropriate pain management, to prevent postpartum relapse and a risk of overdose, and to ensure adequate contraception to prevent unintended pregnancies. Patient stabilization with opioid-assisted therapy is compatible with breastfeeding. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists.

Motivational Interviewing: A Tool for Behavior Change

resources@acog.org — Fri, 16 Nov 2012 12:53:28 -0500

ABSTRACT: Applying the principles of motivational interviewing to everyday patient interactions has been proved effective in eliciting "behavior change" that contributes to positive health outcomes and improved patient–physician communication. Current Procedural Terminology codes are available to aid in obtaining reimbursement for time spent engaging patients in motivational interviewing for some conditions.

Human Trafficking

resources@acog.org — Fri, 16 Nov 2012 12:52:49 -0500

ABSTRACT: Human trafficking is a widespread problem with estimates ranging from 14,000 to 50,000 individuals trafficked into the United States annually. This hidden population involves the commercial sex industry, agriculture, factories, hotel and restaurant businesses, domestic workers, marriage brokers, and some adoption firms. Because 80% of trafficked individuals are women and girls, women's health care providers may better serve their diverse patient population by increasing their awareness of this problem. The exploitation of people of any race, gender, sexual orientation, or ethnicity is unacceptable at any time, in any place. The members of the American College of Obstetricians and Gynecologists should be aware of this problem and strive to recognize and assist their patients who are victims or who have been victims of human trafficking.

Health Literacy

resources@acog.org — Fri, 16 Nov 2012 12:52:28 -0500

ABSTRACT: According to the Institute of Medicine of the National Academies, health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The American College of Obstetricians and Gynecologists is committed to the promotion of health literacy for all. Responsibility for recognizing and addressing the problem of limited health literacy lies with all entities in the health care profession.

Health Care for Transgender Individuals

resources@acog.org — Fri, 16 Nov 2012 12:51:22 -0500

ABSTRACT: Transgender individuals face harassment, discrimination, and rejection within our society. Lack of awareness, knowledge, and sensitivity in health care communities eventually leads to inadequate access to, underutilization of, and disparities within the health care system for this population. Although the care for these patients is often managed by a specialty team, obstetrician–gynecologists should be prepared to assist or refer transgender individuals with routine treatment and screening as well as hormonal and surgical therapies. The American College of Obstetricians and Gynecologists opposes discrimination on the basis of gender identity and urges public and private health insurance plans to cover the treatment of gender identity disorder.

Health Care for Pregnant and Postpartum Incarcerated Women and Adolescent Females

resources@acog.org — Fri, 16 Nov 2012 12:51:17 -0500

ABSTRACT: Clinicians who provide care for incarcerated women should be aware of the special health care needs of pregnant incarcerated women and the specific issues related to the use of restraints during pregnancy and the postpartum period. The use of restraints on pregnant incarcerated women and adolescents may not only compromise health care but is demeaning and rarely necessary.

Health Care for Homeless Women

resources@acog.org — Fri, 16 Nov 2012 12:51:02 -0500

ABSTRACT: Homelessness continues to be a growing problem in the United States. With increasing unemployment and home foreclosures, the recent recession and current economic difficulties are estimated to result in more than 1 million Americans experiencing homelessness through 2011. Women and families represent the fastest growing segment of the homeless population. Health care for these women is a challenge but an issue that needs to be addressed. Homeless women are at higher risk for injury and illness and are less likely to obtain needed health care than women who are not homeless. It is essential to undertake efforts to prevent homelessness, to expand community-based services for the homeless, and provide adequate health care for this underserved population. Health care providers can help address the needs of homeless individuals by identifying their own patients who may be homeless or at risk of becoming homeless, educating these patients about available resources in the community, treating their health problems, and offering preventive care.

Effective Patient - Physician Communication

resources@acog.org — Fri, 16 Nov 2012 12:50:57 -0500

ABSTRACT: Perhaps the greatest contemporary challenge in implementing the principles of effective communication lies in our current health care environment that demands increasing physician productivity and less time with each patient. Effective patient–physician communication with the use of patient-centered interviewing, caring communication skills, and shared decision making will help. The use of physician extenders and, in select situations, e-mail communication with established patients also can be beneficial.

Challenges for Overweight and Obese Urban Women

resources@acog.org — Fri, 16 Nov 2012 12:50:42 -0500

ABSTRACT: Overweight and obesity are epidemic in the United States. Obesity is a risk factor for numerous conditions, including diabetes, hypertension, high cholesterol, stroke, heart disease, certain types of cancer, and arthritis (1). More than one fourth of U.S. women are overweight and more than one third are obese. Women living in urban settings, irrespective of demographics or income, are particularly vulnerable to becoming overweight or obese because of limited resources for physical activity and healthy food choices. Therefore, there is a need for clinicians and public health officials to address not only individual behaviors but also environmental issues in their efforts to reduce the epidemic of obesity in this particular group of the population.

The Obstetric-Gynecologic Hospitalist

resources@acog.org — Fri, 16 Nov 2012 12:48:53 -0500

ABSTRACT: The work models for the obstetric–gynecologic hospitalist and the obstetric laborist are gaining popularity and momentum in hospitals across the nation. These models could be timely solutions to the challenging demands of the general practice of obstetrics and gynecology. The American College of Obstetricians and Gynecologists supports the continued development of the obstetric–gynecologic hospitalist model as one potential solution to achieving increased professional and patient satisfaction while maintaining safe and effective care across delivery settings.

Preparing for Clinical Emergencies in Obstetrics and Gynecology

resources@acog.org — Fri, 16 Nov 2012 12:48:36 -0500

ABSTRACT: Patient care emergencies may periodically occur at any time in any setting, particularly the inpatient setting. To respond to these emergencies, it is important that obstetrician–gynecologists prepare themselves by assessing potential emergencies that might occur, creating plans that include establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.

Patient Safety in the Surgical Environment

resources@acog.org — Fri, 16 Nov 2012 12:48:30 -0500

ABSTRACT: Ensuring patient safety in the operating room begins before the patient enters the operative suite and includes attention to all applicable types of preventable medical errors (including, for example, medication errors), but surgical errors are unique to this environment. Steps to prevent wrong-site, wrong-person, wrong-procedure errors, or retained foreign objects have been recommended, starting with structured communication between the patient, the surgeon(s), and other members of the health care team. Prevention of surgical errors requires the attention of all personnel involved in the patient's care.

Patient Safety and the Electronic Health Record

resources@acog.org — Fri, 16 Nov 2012 12:48:22 -0500

ABSTRACT: The electronic health record (EHR) has the potential to improve the quality, safety, and efficiency of patient care when fully implemented, yet adoption of this tool has been slow. The advantages of the EHR include facilitating improved communication between health care providers; assisting with medication safety, tracking, and reporting; and promoting quality of care through optimized compliance with guidelines. Despite obstacles to widespread adoption and implementation, use of the EHR as a real-time, evidence-based support tool can help busy obstetrician–gynecologists improve the quality of the care they provide through improved care coordination, communication, and documentation.

Disruptive Behavior

resources@acog.org — Fri, 16 Nov 2012 12:48:04 -0500

ABSTRACT: Disruptive physician behavior may have a negative effect on patient care. Consequently, it is important that a systematic process be in place to discourage, identify, and remedy episodes of disruptive behavior.

Emergent Therapy for Acute-Onset Severe Hypertension with Preeclampsia and Eclampsia

resources@acog.org — Fri, 16 Nov 2012 12:46:35 -0500

ABSTRACT: Acute-onset, persistent (lasting 15 minutes or more), severe systolic (greater than or equal to 160 mm Hg) or severe diastolic hypertension (greater than or equal to 110 mm Hg) or both in pregnant or postpartum women with preeclampsia or eclampsia constitutes a hypertensive emergency. Severe systolic hypertension may be the most important predictor of cerebral hemorrhage and infarction in these patients and if not treated expeditiously can result in maternal death. Intravenous labetalol and hydralazine are both considered first-line drugs for the management of acute, severe hypertension in this clinical setting. Close maternal and fetal monitoring by the physician and nursing staff are advised. Order sets for the use of labetalol and hydralazine for the initial management of acute, severe hypertension in pregnant or postpartum women with preeclampsia or eclampsia have been developed.

Influenza Vaccination During Pregnancy

resources@acog.org — Fri, 16 Nov 2012 12:46:19 -0500

ABSTRACT: Preventing influenza during pregnancy is an essential element of prenatal care, and the most effective strategy for preventing influenza is annual immunization. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practice recommends influenza vaccination for all women who will be pregnant through the influenza season (October through May in the United States). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice supports this recommendation. No study to date has shown an adverse consequence of inactivated influenza vaccine in pregnant women or their offspring. Vaccination early in the season and regardless of gestational age is optimal, but unvaccinated pregnant women should be immunized at any time during influenza season as long as the vaccine supply lasts.

Magnesium Sulfate Before Anticipated Preterm Birth for Neuroprotection

resources@acog.org — Fri, 16 Nov 2012 12:46:04 -0500

ABSTRACT: Numerous large clinical studies have evaluated the evidence regarding magnesium sulfate, neuroprotection, and preterm births. The Committee on Obstetric Practice and the Society for Maternal-Fetal Medicine recognize that none of the individual studies found a benefit with regard to their primary outcome. However, the available evidence suggests that magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants. Physicians electing to use magnesium sulfate for fetal neuroprotection should develop specific guidelines regarding inclusion criteria, treatment regimens, concurrent tocolysis, and monitoring in accordance with one of the larger trials.

Moderate Caffeine Consumption During Pregnancy

resources@acog.org — Fri, 16 Nov 2012 12:45:51 -0500

ABSTRACT: Moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a correlation between high caffeine intake and miscarriage.

Vitamin D - Screening and Supplementation During Pregnancy

resources@acog.org — Fri, 16 Nov 2012 12:45:10 -0500

ABSTRACT: During pregnancy, severe maternal vitamin D deficiency has been associated with biochemical evidence of disordered skeletal homeostasis, congenital rickets, and fractures in the newborn. At this time, there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency. For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum 25-hydroxyvitamin D levels can be considered and should be interpreted in the context of the individual clinical circumstance. When vitamin D deficiency is identified during pregnancy, most experts agree that 1,000–2,000 international units per day of vitamin D is safe. Higher dose regimens used for treatment of vitamin D deficiency have not been studied during pregnancy. Recommendations concerning routine vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials.

Compendium Online

Thu, 15 Nov 2012 12:13:53 -0500

Analgesia and Cesarean Delivery Rates

resources@acog.org — Wed, 14 Nov 2012 16:10:00 -0500

ABSTRACT: Neuraxial analgesia techniques are the most effective and least depressant treatments for labor pain. The American College of Obstetricians and Gynecologists previously recommended that practitioners delay initiating epidural analgesia in nulliparous women until the cervical dilatation reached 4–5 cm. However, more recent studies have shown that epidural analgesia does not increase the risks of cesarean delivery. The choice of analgesic technique, agent, and dosage is based on many factors, including patient preference, medical status, and contraindications. The fear of unnecessary cesarean delivery should not influence the method of pain relief that women can choose during labor.

September-October 2011

resources@acog.org — Mon, 05 Nov 2012 14:39:41 -0500

Not If, But When: Coping With the Stress of Liability Litigation

September-October 2010

resources@acog.org — Mon, 05 Nov 2012 14:39:17 -0500

Medical Liability Reform: A look at the landscape

September 2009

resources@acog.org — Mon, 05 Nov 2012 14:38:54 -0500

Liability issues continue to cause changes in practice; How to manage patients with depression during pregnancy

September 2008

resources@acog.org — Mon, 05 Nov 2012 14:38:30 -0500

Experts develop national plan to improve preterm birth; 2009 postgraduate courses announced

September 2007

resources@acog.org — Mon, 05 Nov 2012 14:38:11 -0500

ABOG to present free webcast on maintenance of certification; States enact perinatal HIV legislation

September 2006

resources@acog.org — Mon, 05 Nov 2012 14:37:52 -0500

ACOG releases HPV vaccine recommendations; After a break from practice, returning not easy

September 2005

resources@acog.org — Mon, 05 Nov 2012 14:37:31 -0500

How to manage abnormal cervical cytology; ACOG links medical students with ob-gyn mentors

September 2004

resources@acog.org — Mon, 05 Nov 2012 14:37:05 -0500

ACOG helps pregnant women say no to smoking; Can we talk? Speaking about weight with your patients

October 2009

resources@acog.org — Mon, 05 Nov 2012 14:36:10 -0500

Advances in breast cancer screening, diagnosis, and treatment

October 2008

resources@acog.org — Mon, 05 Nov 2012 14:35:23 -0500

Weak economy hits ob-gyn practices; 2009 FIGO Congress, South Africa

October 2007

resources@acog.org — Mon, 05 Nov 2012 14:35:02 -0500

Guidelines revamped as resource manual for women’s health care; ABOG to present free webcast on
maintenance of certification

October 2006

resources@acog.org — Mon, 05 Nov 2012 14:34:40 -0500

Emergency contraception approval restricted; Exploring options for returning to practice

October 2005

resources@acog.org — Mon, 05 Nov 2012 14:34:18 -0500

Emergency contraception hot topic in state legislatures; Paperless practices: Reality or fantasy?

October 2004

resources@acog.org — Mon, 05 Nov 2012 14:33:14 -0500

ACOG task force releases hormone therapy guide; Mammograms saving lives, but disparities still exist

November-December 2009

resources@acog.org — Mon, 05 Nov 2012 14:32:28 -0500

Minority ob-gyns encouraged by powerful mentors

November-December 2008

resources@acog.org — Mon, 05 Nov 2012 14:29:27 -0500

Nontraditional Junior Fellows embrace ob-gyn as second career; Complete liability survey and win

November-December 2007

resources@acog.org — Mon, 05 Nov 2012 14:28:57 -0500

ACOG calls colonoscopy preferred screening method; Gaps remain in women’s cancer knowledge

November-December 2006

resources@acog.org — Mon, 05 Nov 2012 14:28:32 -0500

Ob-gyns change practice because of liability rates, fears; Research support needed to investigate preterm birth

November-December 2005

resources@acog.org — Mon, 05 Nov 2012 14:27:42 -0500

Hurricanes displace Fellows, close practices; Ob-gyns work around the clock during Hurricane Katrina

November-December 2004

resources@acog.org — Mon, 05 Nov 2012 14:27:15 -0500

Patients unaware of heart disease risks; 2005 ACM: San Francisco here we come

November 2010

resources@acog.org — Mon, 05 Nov 2012 14:26:29 -0500

Culturally Competent Care: Conocimiento Cultural de su Paciente

May-June 2011

resources@acog.org — Mon, 05 Nov 2012 14:26:02 -0500

Ralph W. Hale, MD Special Tribute

May-June 2009

resources@acog.org — Mon, 05 Nov 2012 14:25:42 -0500

Front desk staff presents the face of your practice; Ob-gyn finds more than a hobby
in art of glassblowing

May-June 2008

resources@acog.org — Mon, 05 Nov 2012 14:23:11 -0500

For American Indians, health care needs grow, money doesn’t; Match numbers remain strong

May-June 2007

resources@acog.org — Mon, 05 Nov 2012 14:22:48 -0500

Expanding geriatric training as population ages; Too few young women being screened for chlamydia

May-June 2006

resources@acog.org — Mon, 05 Nov 2012 14:22:24 -0500

The future of medical school education; pause™ celebrates 10 years of informing women

May-June 2005

resources@acog.org — Mon, 05 Nov 2012 14:21:56 -0500

Fellows leading the way in public health; ACOG book addresses underserved women

May-June 2004

resources@acog.org — Mon, 05 Nov 2012 14:21:35 -0500

Week calls attention to plight of uninsured; Latest ACOG survey develops a profi le of Fellows’ practices

March 2011

resources@acog.org — Mon, 05 Nov 2012 14:21:05 -0500

Workforce Changes: Closing the Gap

March 2009

resources@acog.org — Mon, 05 Nov 2012 14:20:34 -0500

Patient safety expert to lead off ACM President’s Program; Fran Drescher to speak at the ACM

March 2008

resources@acog.org — Mon, 05 Nov 2012 14:20:04 -0500

Former presidential adviser to address ACM audience; Obesity’s effect on a patient’s fertility

March 2007

resources@acog.org — Mon, 05 Nov 2012 14:19:41 -0500

ACM President’s Program to feature stellar speakers; Ob-gyns can help reduce colorectal cancer deaths in US

March 2006

resources@acog.org — Mon, 05 Nov 2012 14:19:20 -0500

Summit leads renewed focus on patient safety; Fellows can allay colorectal cancer test fears

March 2005

resources@acog.org — Mon, 05 Nov 2012 14:18:33 -0500

Military ob-gyns prove versatility of specialty; EC use doesn’t lead to more unsafe sex

March 2004

resources@acog.org — Mon, 05 Nov 2012 14:17:44 -0500

More ob-gyns changing practice because of liability insurance rates, fear of claims; March is National Colorectal Cancer Awareness month

June 2010

resources@acog.org — Mon, 05 Nov 2012 14:17:13 -0500

Health Care Reform: What it means to you and your patients

July 2011

resources@acog.org — Mon, 05 Nov 2012 14:16:45 -0500

Telemedicine: Bringing Specialty Consultation and Medical Education to Rural Areas

July 2010

resources@acog.org — Mon, 05 Nov 2012 14:16:24 -0500

The Adolescent Patient: Beginning a lifetime of care

July 2009

resources@acog.org — Mon, 05 Nov 2012 14:15:55 -0500

New president to focus on postpartum depression

July 2008

resources@acog.org — Mon, 05 Nov 2012 14:15:29 -0500

New president to focus on patient safety

July 2007

resources@acog.org — Mon, 05 Nov 2012 14:15:08 -0500

Ob-gyns are champions of women’s health care

July 2006

resources@acog.org — Mon, 05 Nov 2012 14:14:41 -0500

Dr. Laube calls for changes in medical education

July 2005

resources@acog.org — Mon, 05 Nov 2012 14:14:19 -0500

New president: it’s time to change

July 2004

resources@acog.org — Mon, 05 Nov 2012 14:13:51 -0500

New president calls on Fellows to embrace Women’s Health Bill of Rights;

January-February 2011

resources@acog.org — Mon, 05 Nov 2012 14:13:26 -0500

ACM Special Preview: 59th Annual Clinical Meeting, Washington DC, April 30 - May 4, 2011

January 2009

resources@acog.org — Mon, 05 Nov 2012 14:13:00 -0500

New administration to tackle health care reform; President-Elect Obama urged to
protect women’s reproductive rights

January 2008

resources@acog.org — Mon, 05 Nov 2012 14:11:57 -0500

The future of ob-gyn practice; Do your patients understand you?

January 2007

resources@acog.org — Mon, 05 Nov 2012 14:10:53 -0500

The new Congress and women’s health care; Women vulnerable to methamphetamine

January 2006

resources@acog.org — Mon, 05 Nov 2012 14:10:32 -0500

Women lack knowledge about gynecologic cancers; Complete ACOG survey and win

January 2005

resources@acog.org — Mon, 05 Nov 2012 14:10:00 -0500

Medical liability reform gains national attention; HPV vaccine on the horizon

January 2004

resources@acog.org — Mon, 05 Nov 2012 14:09:02 -0500

Putting new Pap test guidelines into practice; New Green Journal website offers exceptional online services

February 2009

resources@acog.org — Mon, 05 Nov 2012 14:08:12 -0500

Ob-gyns get motivated to lead healthier lives; ACOG’s new business organization created to meet members’ needs

February 2008

resources@acog.org — Mon, 05 Nov 2012 14:07:12 -0500

Many patients embrace alternative medicine; ACM scientific sessions announced

February 2007

resources@acog.org — Mon, 05 Nov 2012 14:06:52 -0500

National program develops ob-gyn researchers; Historical photos donated to ACOG

February 2006

resources@acog.org — Mon, 05 Nov 2012 14:06:33 -0500

Junior Fellow leaders gather for ACOG orientation; Register now for 2006 ACM

February 2005

resources@acog.org — Mon, 05 Nov 2012 14:06:12 -0500

Questions about bone mass and Depo-Provera; ACOG’s Plum magazine debuts

February 2004

resources@acog.org — Mon, 05 Nov 2012 14:05:43 -0500

Medical liability reform: The future of our specialty rests with us

December 2010

resources@acog.org — Mon, 05 Nov 2012 14:05:12 -0500

HIV and Women: New approaches to patient care

August 2011

resources@acog.org — Mon, 05 Nov 2012 14:04:37 -0500

Women and Alcohol: How Much is Too Much?

August 2010

resources@acog.org — Mon, 05 Nov 2012 14:04:09 -0500

New VBAC Guidelines: What they mean to you and your patients

August 2009

resources@acog.org — Mon, 05 Nov 2012 14:03:41 -0500

How much weight patients should gain in pregnancy

August 2008

resources@acog.org — Mon, 05 Nov 2012 14:01:38 -0500

ACOG recommends routine HIV testing for women ages 19–64; Feds to revamp Rx labels for pregnancy

August 2007

resources@acog.org — Mon, 05 Nov 2012 13:57:36 -0500

Fellows strive to improve health care structure in Iraq; Can small practices afford EMRs?

August 2006

resources@acog.org — Mon, 05 Nov 2012 13:56:53 -0500

All pregnant patients should undergo psychosocial screening; Residents embrace exchange opportunity in Japan

August 2005

resources@acog.org — Mon, 05 Nov 2012 13:55:43 -0500

Five states achieve medical liability reform wins; Exchange program unites US and Japan residents

August 2004

resources@acog.org — Mon, 05 Nov 2012 13:51:34 -0500

New campaign encourages women to breastfeed; A crisis hitting America’s waistline

April-May 2010

resources@acog.org — Mon, 05 Nov 2012 13:48:31 -0500

ACM 2010: The American College of Obstetricians and Gynecologists 58th Annual Clinical Meeting, May 15-19, 2010, San Francisco

April 2011

resources@acog.org — Mon, 05 Nov 2012 13:48:01 -0500

Preventive Care: Essential Assessments for Women at Every Stage of Life

April 2009

resources@acog.org — Mon, 05 Nov 2012 13:47:26 -0500

ACM program expands in return to Windy City; ACOG members invited to
revamped ACM meeting

April 2008

resources@acog.org — Mon, 05 Nov 2012 13:44:59 -0500

What is Maintenance of Certification?; Provocative ACM session to examine
solutions to medical liability crisis

April 2007

resources@acog.org — Mon, 05 Nov 2012 13:43:09 -0500

Double dose of HPV vaccine sessions at ACM; ACM session to spotlight new Down syndrome screening guidelines

April 2006

resources@acog.org — Mon, 05 Nov 2012 13:42:11 -0500

ACM session to examine racial disparities in women’s health; Proposed regulations open door for
more computer use in practice

April 2005

resources@acog.org — Mon, 05 Nov 2012 13:41:41 -0500

Ob-gyn program trains 30+ doctors in Ghana; Extraordinary ACM planned for May 7–11 in San Francisco

April 2004

resources@acog.org — Mon, 05 Nov 2012 13:40:39 -0500

Prenatal ultrasound portrait studios find market niche; Join colleagues at the ACM in Philadelphia

February 2012

resources@acog.org — Mon, 05 Nov 2012 13:38:49 -0500

Get a preview of the Annual Clinical Meeting with the February 2012 issue of the ACOG Today newsletter.

July 2012

resources@acog.org — Mon, 05 Nov 2012 13:33:17 -0500

Giving back to your community. Service is an inherent part of being an ob-gyn. Beyond helping our patients, we often strive to serve our greater community, volunteering at homeless shelters and women's clinics, raising money for local organizations, or responding to natural disasters around the world with our medical expertise. On pages 5–9 in this issue of ACOG Today, we showcase service projects started by Junior Fellows who are giving back to their communities, while also inspiring other ACOG members to get involved.

Quality and Safety in Womens Health Care

Fri, 26 Oct 2012 15:10:18 -0400

http://www.acog.org/~/media/Quality%20and%20Safety%20in%20Womens%20Health%20Care/QualityAndSafety.pdf

The Apgar Score

resources@acog.org — Tue, 23 Oct 2012 10:26:05 -0400

ABSTRACT: The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.

Statement on Surgical Assistants

resources@acog.org — Tue, 23 Oct 2012 10:25:44 -0400

Scheduled Cesarean Delivery and the Prevention of Vertical Transmission of HIV Infection

resources@acog.org — Tue, 23 Oct 2012 10:25:31 -0400

Prenatal and Perinatal Human Immunodeficiency Virus Testing - Expanded Recommendations

resources@acog.org — Tue, 23 Oct 2012 10:25:08 -0400

ABSTRACT: Early identification and treatment of all pregnant women with human immunodeficiency virus (HIV) is the best way to prevent neonatal disease and improve the woman's health. Human immunodeficiency virus screening is recommended for all pregnant women after they are notified that they will be tested for HIV infection as part of the routine panel of prenatal blood tests unless they decline the test (ie, opt-out screening). Repeat testing in the third trimester, or rapid HIV testing at labor and delivery as indicated or both also are recommended as additional strategies to further reduce the rate of perinatal HIV transmission. The American College of Obstetricians and Gynecologists makes the following recommendations: obstetrician–gynecologists should follow opt-out prenatal HIV screening where legally possible; repeat conventional or rapid HIV testing in the third trimester is recommended for women in areas with high HIV prevalence, women known to be at high risk for acquiring HIV infection, and women who declined testing earlier in pregnancy; rapid HIV testing should be used in labor for women with undocumented HIV status following opt-out screening; and if a rapid HIV test result in labor is positive, immediate initiation of antiretroviral prophylaxis should be recommended without waiting for the results of the confirmatory test.

Pain Relief During Labor

resources@acog.org — Tue, 23 Oct 2012 10:24:48 -0400

ABSTRACT: Pain management should be provided whenever medically indicated. The American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG) believe that women requesting epidural analgesia during labor should not be deprived of this service based on their insurance or inadequate nursing participation in the management of regional analgesic modalities. Furthermore, in an effort to allow the maximum number of patients to benefit from neuraxial analgesia, ASA and ACOG believe that labor nurses should not be restricted from participating in the management of pain relief during labor.

Oral Intake During Labor

resources@acog.org — Tue, 23 Oct 2012 10:24:36 -0400

ABSTRACT: There is insufficient evidence to address the safety of any particular fasting period for solids in obstetric patients. Expert opinion supports that patients undergoing either elective cesarean delivery or elective postpartum tubal ligation should undergo a fasting period of 6–8 hours. Adherence to a predetermined fasting period before nonelective surgical procedures (ie, cesarean delivery) is not possible. Therefore, solid foods should be avoided in laboring patients.

Obstetric Management of Patients with Spinal Cord Injuries

resources@acog.org — Tue, 23 Oct 2012 10:24:24 -0400

ABSTRACT: Effective rehabilitation and modern reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries (SCIs). It is important that obstetricians caring for these patients are aware of the specific problems related to SCIs. Autonomic dysreflexia is the most significant medical complication seen in women with SCIs, and precautions should be taken to avoid stimuli that can lead to this potentially fatal syndrome. Women with SCIs may give birth vaginally, but when cesarean delivery is indicated, adequate anesthesia (spinal or epidural if possible) is needed.

Management of Delivery of a Newborn With Meconium-Stained Amniotic Fluid

resources@acog.org — Tue, 23 Oct 2012 10:23:43 -0400

ABSTRACT: In accordance with the new guidelines from the American Academy of Pediatrics and the American Heart Association, all infants with meconium-stained amniotic fluid should no longer routinely receive intrapartum suctioning. If meconium is present and the newborn is depressed, the clinician should intubate the trachea and suction meconium and other aspirated material from beneath the glottis.

Late-Preterm Infants

resources@acog.org — Tue, 23 Oct 2012 10:16:49 -0400

ABSTRACT: Late–preterm infants (defined as infants born between 34 0/7 weeks and 36 6/7 weeks of gestation) often are mistakenly believed to be as physiologically and metabolically mature as term infants. However, compared with term infants, late–preterm infants are at higher risk than term infants of developing medical complications, resulting in higher rates of infant mortality, higher rates of morbidity before initial hospital discharge, and higher rates of hospital readmission in the first months of life. Preterm delivery should occur only when an accepted maternal or fetal indication for delivery exists. Collaborative counseling by both obstetric and neonatal clinicians about the outcomes of late–preterm births is warranted unless precluded by emergent conditions.

Guidelines for Diagnostic Imaging During Pregnancy

resources@acog.org — Tue, 23 Oct 2012 10:16:28 -0400

ABSTRACT: Undergoing a single diagnostic X-ray procedure does not result in radiation exposure adequate to threaten the well-being of the developing preembryo, embryo, or fetus and is not an indication for therapeutic abortion. When multiple diagnostic X-rays are anticipated during pregnancy, imaging procedures not associated with ionizing radiation, such as ultrasonography and magnetic resonance imaging, should be considered. Additionally, it may be helpful to consult an expert in dosimetry calculation to determine estimated fetal dose. The use of radioactive isotopes of iodine is contraindicated for therapeutic use during pregnancy. Other radiopaque and paramagnetic contrast agents have not been studied in humans, but animal studies suggest that these agents are unlikely to cause harm to the developing human fetus. Although imaging techniques requiring these agents may be diagnostically beneficial, these techniques should be used during pregnancy only if potential benefits justify potential risks to the fetus.

Fetal Monitoring Prior to Scheduled Cesarean Delivery

resources@acog.org — Tue, 23 Oct 2012 10:16:16 -0400

ABSTRACT: There are insufficient data to determine the value of fetal monitoring prior to scheduled cesarean delivery in patients without risk factors.

Vulvodynia

resources@acog.org — Tue, 23 Oct 2012 10:13:26 -0400

ABSTRACT: Vulvodynia is a complex disorder that can be difficult to treat. It is described by most patients as burning, stinging, irritation, or rawness. Many treatment options have been used, including vulvar care measures, medication, biofeedback training, physical therapy, dietary modifications, sexual counseling, and surgery. A cotton swab test is used to distinguish generalized disease from localized disease. No one treatment is effective for all patients. A number of measures can be taken to prevent irritation, and several medications can be used to treat the condition.

The Role of Cystourethroscopy in the Generalist Obstetrician-Gynecologist Practice

resources@acog.org — Tue, 23 Oct 2012 10:13:03 -0400

ABSTRACT: Cystourethroscopy can be performed for diagnostic and a few operative indications by obstetrician–gynecologists to help improve patient care. Perhaps the most important indications for cystourethroscopy are to rule out cystotomy and intravesical or intraurethral suture or mesh placement and to verify bilateral ureteral patency during or after certain gynecologic surgical procedures. The granting of privileges for cystourethroscopy and other urogynecologic procedures should be based on training, experience, and demonstrated competence. Postgraduate education, including residency training programs in obstetrics and gynecology and continuing medical education, should include education in the instrumentation, technique, and evaluation of findings of cystourethroscopy, and in the pathophysiology of diseases of the lower urinary tract.

Although many of the pioneers of cystourethroscopy, most notably Howard Kelly, were gynecologists, for decades the procedure has been performed mainly by urologists. However, cystourethroscopy can be performed for diagnostic and a few operative indications by obstetrician–gynecologists to help improve patient care. This document reviews the definition and indications for cystourethroscopy and discusses the evidence and recommendations for its use in the generalist obstetrician–gynecologist practice. situations and be prepared to respond in a professional, ethical manner to patient requests for information and procedures.

Tamoxifen and Uterine Cancer

resources@acog.org — Tue, 23 Oct 2012 10:12:50 -0400

ABSTRACT: Tamoxifen may be associated with endometrial proliferation, hyperplasia, polyp formation, invasive carcinoma, and uterine sarcoma. Any symptoms of endometrial hyperplasia or cancer reported by a postmeno-pausal woman taking tamoxifen should be evaluated. Premenopausal women treated with tamoxifen have no known increased risk of uterine cancer and as such require no additional monitoring beyond routine gynecologic care. If atypical endometrial hyperplasia develops, appropriate gynecologic management should be instituted, and the use of tamoxifen should be reassessed.

Supracervical Hysterectomy

resources@acog.org — Tue, 23 Oct 2012 10:12:39 -0400

ABSTRACT: Women with known or suspected gynecologic cancer, current or recent cervical dysplasia, or endometrial hyperplasia are not candidates for a supracervical procedure. Patients electing supracervical hysterectomy should be carefully screened preoperatively to exclude cervical or uterine neoplasm and should be counseled about the need for long-term follow-up, the possibility of future trachelectomy, and the lack of data demonstrating clear benefits over total hysterectomy. The supracervical approach should not be recommended by the surgeon as a superior technique for hysterectomy for benign disease.

Routine Human Immunodeficiency Virus Screening

resources@acog.org — Tue, 23 Oct 2012 10:12:29 -0400

ABSTRACT: The American College of Obstetricians and Gynecologists recommends routine human immunodeficiency virus (HIV) screening for women aged 19–64 years and targeted screening for women with risk factors outside of that age range. Ideally, opt-out HIV screening should be performed, in which the patient is notified that HIV testing will be performed as a routine part of gynecologic and obstetric care, unless the patient declines testing (1). The American College of Obstetricians and Gynecologists recommends that obstetrician–gynecologists annually review patients' risk factors for HIV and assess the need for retesting.

Professional Liability and Gynecology-Only Practice

resources@acog.org — Tue, 23 Oct 2012 10:12:16 -0400

ABSTRACT: Fellows of the American College of Obstetricians and Gynecologists may choose to limit the scope of their practices to gynecology. The College considers early pregnancy care (often up to 12–14 weeks of gestation) to be within the scope of gynecology and gynecologic practice. Liability insurers who provide coverage for "gynecology-only" practices should provide coverage for clinical practice activities that involve the management of early pregnancy and its complications.

Nongynecologic Procedures

resources@acog.org — Tue, 23 Oct 2012 10:11:49 -0400

Intraperitoneal Chemotherapy for Ovarian Cancer

resources@acog.org — Tue, 23 Oct 2012 10:11:34 -0400

ABSTRACT: Postoperative intravenous (IV) chemotherapy for advanced stage ovarian cancer has been the standard treatment. Recent studies have found significant survival advantages with the use of adjuvant intraperitoneal (IP) chemotherapy. Combination IV/IP chemotherapy may be an option for well counseled, carefully selected patients with optimally debulked stage III ovarian cancer. However, IV/IP treatment also has increased rates of pain, fatigue, and hematologic, gastrointestinal, metabolic, and neurologic toxicities. Given the balance of efficacy, quality of life, and toxicity, the decision to use IP chemotherapy must be individualized.

Induced Abortion and Breast Cancer Risk

resources@acog.org — Tue, 23 Oct 2012 10:11:26 -0400

ABSTRACT: The relationship between induced abortion and the subsequent development of breast cancer has been the subject of a substantial amount of epidemiologic study. Early studies of the relationship between prior induced abortion and breast cancer risk were methodologically flawed. More rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.

Brand Versus Generic Oral Contraceptives

resources@acog.org — Tue, 23 Oct 2012 10:10:24 -0400

ABSTRACT:The U.S. Food and Drug Administration considers generic and brand name oral contraceptive (OC) products clinically equivalent and interchangeable. The American College of Obstetricians and Gynecologists supports patient or clinician requests for branded OCs or continuation of the same generic or branded OCs if the request is based on clinical experience or concerns regarding packaging or compliance, or if the branded product is considered a better choice for that individual patient.

Screening for Tay - Sachs Disease

resources@acog.org — Tue, 23 Oct 2012 10:09:52 -0400

ABSTRACT: Tay–Sachs disease (TSD) is a severe progressive neurologic disease that causes death in early childhood. Carrier screening should be offered before pregnancy to individuals and couples at high risk, including those of Ashkenazi Jewish, French–Canadian, or Cajun descent and those with a family history consistent with TSD. If both partners are determined to be carriers of TSD, genetic counseling and prenatal diagnosis should be offered.

Patents Medicine and the Interests of Patients

resources@acog.org — Tue, 23 Oct 2012 10:07:06 -0400

ABSTRACT: Many basic scientists and clinicians support the right to obtain and enforce patents on drugs, diagnostic tests, medical devices, and most recently, genes. Although those who develop useful drugs, diagnostic and screening tests, and medical technologies have the right to expect a fair return for their efforts and risks, current interpretations of patent law have the potential to impede rather than promote scientific and medical advances. Policies regarding the patenting of scientific inventions, discoveries, and improvements must balance the need for the open exchange and use of information with the need to make the pursuit of such knowledge financially rewarding.

Coding Responsibility

resources@acog.org — Tue, 23 Oct 2012 10:05:28 -0400

Menstruation in Girls and Adolescents - Using the Menstrual Cycle as a Vital Sign

resources@acog.org — Tue, 23 Oct 2012 10:04:52 -0400

ABSTRACT: Young patients and their parents often are unsure about what represents normal menstrual patterns, and clinicians also may be unsure about normal ranges for menstrual cycle length and amount and duration of flow through adolescence. It is important to be able to educate young patients and their parents regarding what to expect of a first period and about the range for normal cycle length of subsequent menses. It is equally important for clinicians to have an understanding of bleeding patterns in girls and adolescents, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate young patients' conditions appropriately. Using the menstrual cycle as an additional vital sign adds a powerful tool to the assessment of normal development and the exclusion of serious pathologic conditions.

Menstrual Manipulation for Adolescents With Disabilities

resources@acog.org — Mon, 22 Oct 2012 16:15:19 -0400

ABSTRACT: Defining the reasons for intervention and the precise goal of treatment are the most critical issues regarding use of interventions to alter menstrual flow in adolescents with disabilities. Reasons for intervention may relate to abnormal uterine bleeding, hygiene, mood issues, fear of pregnancy, and acute onset of other medical conditions. Goals of treatment may include a decrease in the amount of bleeding, periodic amenorrhea, or treatment of symptoms, such as mood issues or dysmenorrhea. First-line treatment options should be safe, minimally invasive, and nonpermanent. Endometrial ablation has not been studied in adolescents, has not been studied long-term, is considered irreversible and, therefore, is not recommended in teenagers.

Patient Safety in Obstetrics and Gynecology

resources@acog.org — Mon, 22 Oct 2012 16:03:12 -0400

ABSTRACT: Since publication of the Institute of Medicine's landmark report To Err is Human: Building a Safer Health System, emphasis on patient safety has steadily increased. Obstetrician–gynecologists should continuously incorporate elements of patient safety into their practices and also encourage others to use these practices.

Induction of Labor

resources@acog.org — Tue, 09 Oct 2012 14:39:27 -0400

More than 22% of all gravid women undergo induction of labor in the United States, and the overall rate of induction of labor in the United States has more than doubled since 1990 to 225 per 1,000 live births in 2006 (1). The goal of induction of labor is to achieve vaginal delivery by stimulating uterine contractions before the spontaneous onset of labor. Generally, induction of labor has merit as a therapeutic option when the benefits of expeditious delivery outweigh the risks of continuing the pregnancy. The benefits of labor induction must be weighed against the potential maternal and fetal risks associated with this procedure (2). The purpose of this document is to review current methods for cervical ripening and induction of labor and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. These practice guidelines classify the indications for and contraindications to induction of labor, describe the various agents used for cervical ripening, cite methods used to induce labor, and outline the requirements for the safe clinical use of the various methods of inducing labor.

Chronic Pelvic Pain

resources@acog.org — Thu, 27 Sep 2012 09:42:58 -0400

Pain in the pelvic area that lasts for 6 months or longer is called chronic pelvic pain. An estimated 15–20% of women aged 18–50 years have chronic pelvic pain that has lasted for more than 1 year.

Community Involvement and Volunteerism

resources@acog.org — Fri, 21 Sep 2012 11:48:49 -0400

ABSTRACT: As professional and community leaders, obstetrician–gynecologists have unlimited opportunities to become involved in and have a positive impact on local, national, and international communities and organizations. Volunteering outside of daily work routines often revitalizes a commitment to medicine while serving as a much needed resource to the community.

Clinical Updates in Womens Health Care

Thu, 13 Sep 2012 13:56:42 -0400

Long-Acting Reversible Contraception -- Implants and Intrauterine Devices

resources@acog.org — Thu, 06 Sep 2012 06:44:40 -0400

Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARCs), are the most effective reversible contraceptives. The major advantage of LARCs compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the user for long-term and effective use. In addition, return of fertility is rapid after the removal of the device (1, 2). The purpose of this Practice Bulletin is to provide information for appropriate candidate selection and the management of clinical issues and complications associated with LARC use.

Guidelines for Adolescent Health Care

Fri, 24 Aug 2012 12:13:29 -0400

http://www.acog.org/~/media/Guidelines%20for%20Adolescent%20Health%20Care/GuidelinesForAdolescentHealth.pdf

Appendixes

Fri, 24 Aug 2012 09:32:36 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Appendixes.pdf

Certification and Procedural Credentialing

resources@acog.org — Thu, 09 Aug 2012 12:43:49 -0400

Resident training in obstetrics and gynecology incorporates the full spectrum of obstetric and gynecologic practice as defined in the special requirements promulgated by the Accreditation Council for Graduate Medical Education (ACGME). These include diagnostic, therapeutic and operative procedures used in the practice of the specialty. The certification process of the American Board of Obstetrics and Gynecology Inc. (ABOG) evaluates medical knowledge and patient care skills of individual practitioners in the broad range of obstetrics, gynecology and women’s health care. The Maintenance of Certification process, developed by ABOG, measures acquisition of new scientific knowledge and new practice guidelines as well as continuing proficiency in the range of practice in which the individual is currently engaged.

The Role of the Obstetrician-Gynecologist in Cosmetic Procedures

resources@acog.org — Thu, 09 Aug 2012 12:41:12 -0400

As cosmetic procedures receive increased attention from the media and patient requests for such procedures grow, there is a corresponding need to determine the proper role of obstetrician–gynecologists in this evolving field. A growing number of women are seeking service locations that provide “one-stop shopping” for both medical and aesthetic services. Some obstetrician–gynecologists have offered cosmetic services as an extension of providing gynecologic care, such as providing hair removal and acne treatment to patients with polycystic ovary syndrome.

Global Womens Health and Rights

resources@acog.org — Wed, 08 Aug 2012 12:35:22 -0400

Acknowledging the significant interplay of women's human rights with the overall health of women and society, the American College of Obstetricians and Gynecologists and the American Congress of Obstetricians and Gynecologists (ACOG) ardently support efforts to improve the dignity, autonomy, rights and health of women in the United States and globally.

Episiotomy

Mon, 30 Jul 2012 15:54:20 -0400

Episiotomia - Los precedimientos y las technicas de reparacion

Mon, 30 Jul 2012 15:53:34 -0400

http://www.acog.org/~/media/Episiotomy/Episiotomia%20-%20Los%20precedimientos%20y%20las%20technicas%20de%20reparacion.pdf

Episiotomy - Procedure and Repair Techniques

Mon, 30 Jul 2012 15:18:04 -0400

http://www.acog.org/~/media/Episiotomy/Episiotomy%20-%20Procedure%20and%20Repair%20Techniques.pdf

Technology Assessments

Mon, 30 Jul 2012 14:06:50 -0400

Task Force and Work Group Reports

Mon, 30 Jul 2012 14:06:31 -0400

Statements of Policy

Mon, 30 Jul 2012 14:06:09 -0400

Special Issues in Womens Health

Mon, 30 Jul 2012 14:05:48 -0400

Practice Bulletins

Mon, 30 Jul 2012 14:05:25 -0400

Guidelines for Womens Health Care

Mon, 30 Jul 2012 14:04:12 -0400

Guidelines for Adolescent Health Care

Mon, 30 Jul 2012 14:03:42 -0400

Committee Opinions

Mon, 30 Jul 2012 13:59:02 -0400

Clinical Review

Mon, 30 Jul 2012 13:58:34 -0400

Patient Education Pamphlets and Fact Sheets

Mon, 30 Jul 2012 13:57:44 -0400

Index

Mon, 30 Jul 2012 11:27:30 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Index.pdf

Special Issues

Mon, 30 Jul 2012 11:18:03 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Special%20Issues.pdf

Special Populations

Mon, 30 Jul 2012 11:05:00 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Special%20Populations.pdf

Improving Access to Quality Health Care for Women

Mon, 30 Jul 2012 10:58:30 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Improving%20Access%20to%20Quality%20Health%20Care.pdf

Preface and Acknowledgments

Mon, 30 Jul 2012 10:43:21 -0400

http://www.acog.org/~/media/Special%20Issues%20in%20Womens%20Health/Preface.pdf

Reproductive Health Care for Adolescents With Disabilities

Mon, 30 Jul 2012 10:30:32 -0400

http://www.acog.org/~/media/Guidelines%20for%20Adolescent%20Health%20Care/ReproductiveHealthCareForAdolescentsWithDisabilities.pdf

Index

Mon, 30 Jul 2012 09:37:54 -0400

http://www.acog.org/~/media/Guidelines%20for%20Womens%20Health%20Care/Index.pdf

Appendixes

Mon, 30 Jul 2012 09:30:06 -0400

http://www.acog.org/~/media/Guidelines%20for%20Womens%20Health%20Care/Appendixes.pdf

Patient Care

Mon, 30 Jul 2012 09:22:52 -0400

http://www.acog.org/~/media/Guidelines%20for%20Womens%20Health%20Care/Patient%20Care.pdf

Organization of Services

Fri, 27 Jul 2012 16:53:40 -0400

http://www.acog.org/~/media/Guidelines%20for%20Womens%20Health%20Care/Organization%20of%20Services.pdf

Governance and Administration

Fri, 27 Jul 2012 16:46:41 -0400

http://www.acog.org/~/media/Guidelines%20for%20Womens%20Health%20Care/Governance%20and%20Administration.pdf