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Committee Opinion Number 524, May 2012

(Reaffirmed 2016)

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. Du...


42.
February 2012

Committee Opinion Number 518, February 2012

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 s...


Committee Opinion Number 501, August 2011

(Reaffirmed 2014)

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 t...


Committee Opinion Number 498, August 2011

(Reaffirmed 2015)

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 o...


Committee Opinion Number 496, August 2011

(Reaffirmed 2013)

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 pregna...


Committee Opinion Number 493, May 2011

(Reaffirmed 2013)

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.


Committee Opinion Number 490, May 2011

(Reaffirmed 2013, Replaces No. 320, November 2005)

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.


Committee Opinion Number 480, March 2011

Reaffirmed 2017

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, ...


Committee Opinion Number 479, March 2011

Reaffirmed 2017

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...


Committee Opinion Number 473, January 2011

(Reaffirmed 2014)

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.


Committee Opinion Number 466, September 2010

(Reaffirmed 2016)

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 i...


Committee Opinion Number 457, June 2010

(Reaffirmed 2016)

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 b...


Committee Opinion Number 456, March 2010

(Reaffirmed 2017)

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.


54.
August 2009

Committee Opinion Number 439, August 2009

(Reaffirmed 2015)

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 ...


Committee Opinion Number 437, July 2009

Reaffirmed 2016

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.


Committee Opinion Number 423, January 2009

Reaffirmed 2016

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.


Committee Opinion Number 410, June 2008

(Reaffirmed 2014)

ABSTRACT: Genetic testing is poised to play an increasing role in the practice of obstetrics and gynecology. To assure patients of the highest quality of care, physicians should become familiar with the currently available array of genetic tests and the tests' limitations. Clinicians should be able to identify patients within their practices who are candidates for genetic testing. Candidates will include patients who are pregnant or considering pregnancy and are at risk for giving birth to affected children as well as gynecology patients who, for example, may have or be predisposed to certain...


Committee Opinion Number 409, June 2008

Reaffirmed 2016

ABSTRACT: Marketing of genetic testing, although similar to direct-to-consumer advertising of prescription drugs, raises additional concerns and considerations. These include issues of limited knowledge among patients and health care providers of available genetic tests, difficulty in interpretation of genetic testing results, lack of federal oversight of companies offering genetic testing, and issues of privacy and confidentiality. Until all of these considerations are addressed, direct or home genetic testing should be discouraged because of the potential harm of a misinterpreted or inaccur...


Committee Opinion Number 390, December 2007

Reaffirmed 2016

ABSTRACT: Physicians vary widely in their familiarity with ethical theories and methods and their sensitivity toward ethical issues. It is important for physicians to improve their skills in addressing ethical questions. Obstetrician–gynecologists who are familiar with the concepts of medical ethics will be better able to approach complex ethical situations in a clear and structured way. By considering the ethical frameworks involving principles, virtues, care and feminist perspectives, concern for community, and case precedents, they can enhance their ability to make ethically justifiable cl...


60.
December 2007

Committee Opinion Number 389, December 2007

(Reaffirmed 2015)

ABSTRACT: Because human immunodeficiency virus (HIV) infection often is detected through prenatal and sexually transmitted disease testing, an obstetrician–gynecologist may be the first health professional to provide care for a woman infected with HIV. Universal testing with patient notification and right of refusal ("opt-out" testing) is recommended by most national organizations and federal agencies. Although opt-out and "opt-in" testing (but not mandatory testing) are both ethically acceptable, the former approach may identify more women who are eligible for therapy and may have public hea...


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