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Committee Opinion Number 649, December 2015

(Replaces Committee Opinion Number 317, October 2005)

ABSTRACT: Projections suggest that people of color will represent most of the U.S. population by 2050, and yet significant racial and ethnic disparities persist in women’s health and health care. Although socioeconomic status accounts for some of these disparities, factors at the patient, practitioner, and health care system levels contribute to existing and evolving disparities in women’s health outcomes. The American College of Obstetricians and Gynecologists is committed to the elimination of racial and ethnic disparities in the health and health care of women and encourages obstetrician–g...


Committee Opinion Number 523, May 2012

(Reaffirmed 2014)

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.


Committee Opinion Number 664, June 2016

(Replaces Committee Opinion Number 321, November 2005)

ABSTRACT: One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus’s well-being, or both. In such circumstances, the obstetrician–gynecologist’s ethical obligation to safeguard the pregnant woman’s autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance—the alternative to respecting a patient’s refusal of treatment—raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power diffe...


184.
October 2012

Committee Opinion Number 537, October 2012

(Reaffirmed 2016)

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 responsibili...


Committee Opinion Number 535, August 2012

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 adol...


Committee Opinion Number 654, February 2016

ABSTRACT: Approximately one half (51%) of the 6 million pregnancies each year in the United States are unintended. A reproductive life plan is a set of personal goals regarding whether, when, and how to have children based on individual priorities, resources, and values. A lack of reproductive life planning, limited access to contraception, and inconsistent use of contraceptive methods contribute to unintended pregnancy. The American College of Obstetricians and Gynecologists strongly supports women’s access to comprehensive and culturally appropriate reproductive life planning and encourages...


Committee Opinion Number 554, February 2013

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 int...


Committee Opinion Number 540, November 2012

(Reaffirmed 2016)

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 Con...


Committee Opinion Number 628, March 2015

ABSTRACT: The field of robotic surgery has developed rapidly, and its use for gynecologic conditions has grown exponentially. Surgeons should be skilled at abdominal and laparoscopic approaches for a specific procedure before undertaking robotic approaches. Surgeon training, competency guidelines, and quality metrics should be developed at the institutional level. Robot-assisted cases should be appropriately selected based on the available data and expert opinion. As with any surgical procedure, repetition drives competency. Ongoing quality assurance is essential to ensure appropriate use of ...


Committee Opinion Number 596, May 2014

(Replaces Committee Opinion Number 411, August 2008) (Reaffirmed 2016)

Abstract: Early diagnosis and treatment of human immunodeficiency virus (HIV) can improve survival and reduce morbidity. The Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists recommend that females aged 13–64 years be tested at least once in their lifetime and annually thereafter based on factors related to risk. In addition, obstetrician–gynecologists should annually review patients’ risk factors for HIV and assess the need for retesting. The opportunity for repeat testing should be made available to all women even in the absence of identi...


Committee Opinion Number 620, January 2015

ABSTRACT: Ovarian cancer has the highest mortality rate out of all types of gynecologic cancer and is the fifth leading cause of cancer deaths among women. Current attempts at screening for ovarian cancer have been unsuccessful and are associated with false-positive test results that lead to unnecessary surgery and surgical complications. Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients. Randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer. The approach to hysterect...


Committee Opinion Number 234, May 2000

(Replaces No. 219, August 1999, Reaffirmed 2015)

Prevention of transmission of the human immunodeficiency virus (HIV) from mother to fetus or newborn (vertical transmission) is a major goal in the care of pregnant women infected with HIV. An important advance in this regard was the demonstration that treatment of the mother with zidovudine (ZDV) during pregnancy and labor and of the neonate for the first 6 weeks after birth could reduce the transmission rate from 25% to 8% (1). Continuing research into vertical transmission of HIV suggests that a substantial number of cases occur as the result of fetal exposure to the virus during labor a...


Committee Opinion Number 630, May 2015

(Replaces Committee Opinion Number 453, February 2010, Reaffirmed 2016)

ABSTRACT: Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects on women, infants, and families. Several screening instruments have been validated for use during pregnancy and the postpartum period. Although definitive ev...


Committee Opinion Number 365, May 2007

Reaffirmed 2016

ABSTRACT: Consultations usually are sought when practitioners with primary clinical responsibility recognize conditions or situations that are beyond their level of expertise or available resources. One way to maximize prompt, effective consultation and collegial relationships is to have a formal consultation protocol. The level of consultation should be established by the referring practitioner and the consultant. The referring practitioner should request timely consultation, explain the consultation process to the patient, provide the consultant with pertinent information, and continue to c...


195.
April 2014

Committee Opinion Number 592, April 2014

(Reaffirmed 2016. Replaces Committee Opinion Number 499, August 2011)

ABSTRACT: Reproductive-aged victims of sexual assault are at risk of unintended pregnancy, sexually transmitted infections, and mental health conditions, including posttraumatic stress disorder. Health care providers should screen routinely for a history of sexual assault and offer victims both emergency contraception and sexually transmitted infection prophylaxis. The health care provider who examines victims of sexual assault has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits.


196.
August 2007

Committee Opinion Number 373, August 2007

Reaffirmed 2016

ABSTRACT: The physician-patient relationship is damaged when there is either confusion regarding professional roles and behavior or clear lack of integrity that allows sexual exploitation and harm. Sexual contact or a romantic relationship between a physician and a current patient is always unethical, and sexual contact or a romantic relationship between a physician and a former patient also may be unethical. The request by either a patient or a physician to have a chaperone present during a physical examination should be accommodated regardless of the physician's sex. If a chaperone is prese...


Committee Opinion Number 471, November 2010

(Replaces No. 316, October 2005. Reaffirmed 2015)

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 ed...


Committee Opinion Number 695, April 2017

(Replaces Committee Opinion Number 371, July 2007)

ABSTRACT: Sterilization is the most common method of contraception among married couples, with nearly twice as many couples choosing female partner sterilization over male sterilization. Although sterilization is among the most straightforward surgical procedures an obstetrician–gynecologist performs, it is enormously complex when considered from a historical, sociological, or ethical perspective. Sterilization practices have embodied a problematic tension, in which some women who desired fertility were sterilized without their knowledge or consent, and other women who wanted sterilization to...


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 494, June 2011

(Reaffirmed 2015)

Abstract: The evidence regarding an association between the nitrofuran and sulfonamide classes of antibiotics and birth defects is mixed. As with all patients, antibiotics should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration. During the second and third trimesters, sulfonamides and nitrofurantoins may continue to be used as first-line agents for the treatment and prevention of urinary tract infections and other infections caused by susceptible organisms. Prescribing sulfonamides or nitrofurantoin in the first trimester is still consi...


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