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81.
January 2015

Committee Opinion Number 618, January 2015

ABSTRACT: The main goal of ovarian reserve testing is to identify those individuals who are at risk of decreased or diminished ovarian reserve, commonly known as DOR. Although ovarian reserve testing cannot predict the end of one’s reproductive years, results outside the range expected for a patient’s age can encourage the individual to pursue more aggressive treatment options to achieve pregnancy. Ovarian reserve testing should be performed for women older than 35 years who have not conceived after 6 months of attempting pregnancy and women at higher risk of diminished ovarian reserve. When ...


Committee Opinion Number 544, December 2012

(Reaffirmed 2016)

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 ...


Committee Opinion Number 484, April 2011

(Reaffirmed 2015)

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 ef...


Committee Opinion Number 671, September 2016

(Replaces Committee Opinion No. 324, November 2005)

ABSTRACT: Over the past decades, the use of assisted reproductive technology (ART) has increased dramatically worldwide and has made pregnancy possible for many infertile couples. Although the perinatal risks that may be associated with ART and ovulation induction are much higher in multifetal gestations, even singletons achieved with ART and ovulation induction may be at higher risk than singletons from naturally occurring pregnancies. However, it remains unclear to what extent these associations might be related to the underlying cause(s) of infertility. Before initiating ART or ovulation i...


85.
September 2016

Committee Opinion Number 673, September 2016

(Replaces Committee Opinion No. 345, October 2006)

ABSTRACT: Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. It can be difficult to treat and rapid resolution is unusual, even with appropriate therapy. Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia. Specialists who may need to be involved include sexual counselors, clinical ps...


Committee Opinion Number 527, June 2012

(Reaffirmed 2016)

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 disorde...


87.
April 2017

Committee Opinion Number 697, April 2017

(Replaces Committee Opinion Number 669, August 2016)

ABSTRACT: In the United States, approximately 35,000 births (0.9%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Although the American College of Obstetricians and Gynecologists believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery. Importantly, women should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include the appropriate selection...


Committee Opinion Number 556, April 2013

(Reaffirmed 2015)

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 ...


Committee Opinion Number 595, May 2014

(Reaffirmed 2016)

Abstract: Preexposure prophylaxis is defined as the administration of antiretroviral medications to individuals who are not infected with human immunodeficiency virus (HIV) and are at the highest risk of acquiring HIV infection. In combination with other proven HIV-prevention methods, preexposure prophylaxis may be a useful tool for women at the highest risk of HIV acquisition. Obstetrician–gynecologists involved in the care of women using preexposure prophylaxis must reinforce adherence to daily medication. The Centers for Disease Control and Prevention’s guidance for preexposure prophylaxis...


Committee Opinion Number 590, March 2014

(Reaffirmed 2016. Replaces Committee Opinion Number 487, April 2011)

ABSTRACT: Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician–gynecologists prepare themselves by assessing potential emergencies, 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.


Committee Opinion Number 605, July 2014

(Reaffirmed 2016)

ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. Health care providers who make this clinical diagnosis should be mindful of the sensitive nature of this medical condition. Patients and their families should be counseled on the effect of the patient’s condition on future fertility, on the risk of comorbidities associated with primary ovarian insufficiency, and on the condition’s p...


Committee Opinion Number 567, July 2013

(Replaces No. 408, June 2008, Reaffirmed 2015)

ABSTRACT: Fellows of the American College of Obstetricians and Gynecologists may choose to limit the scope of their practices to gynecology and, accordingly, may choose not to carry professional liability coverage for obstetrics. The American College of Obstetricians and Gynecologists considers early pregnancy care to be within the scope of gynecology and gynecologic practice. Liability insurers that provide coverage for gynecology-only practices should provide coverage for clinical practice activities that involve the management of first-trimester and early second-trimester pregnancy and its...


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 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...


100.
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.


American Congress of Obstetricians and Gynecologists
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