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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...


Committee Opinion Number 601, June 2014

(Replaces Committee Opinion Number 336, June 2006) (Reaffirmed 2016)

ABSTRACT: Tamoxifen, a nonsteroidal antiestrogen agent, is widely used as adjunctive therapy for women with breast cancer, and it has been approved by the U.S. Food and Drug Administration for adjuvant treatment of breast cancer, treatment of metastatic breast cancer, and reduction in breast cancer incidence in high-risk women. Tamoxifen use may be extended to 10 years based on new data demonstrating additional benefit. Women taking tamoxifen should be informed about the risks of endometrial proliferation, endometrial hyperplasia, endometrial cancer, and uterine sarcomas, and any abnormal vag...


183.
October 2015

Committee Opinion Number 644, October 2015

(Replaces Committee Opinion Number 333, May 2006)

ABSTRACT: The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecolog...


Committee Opinion Number 313, September 2005

(Reaffirmed 2015)

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.


Committee Opinion Number 639, September 2015

ABSTRACT: Information from vital records is critical to identify and quantify health-related issues and to measure progress toward quality improvement and public health goals. In particular, maternal and infant mortality serve as important indicators of the nation’s health, thereby influencing policy development, funding of programs and research, and measures of health care quality. Accurate and timely documentation of births and deaths is essential to high-quality vital statistics. This Committee Opinion describes the process by which births, maternal deaths, and fetal deaths are registered;...


Committee Opinion Number 598, May 2014

(Replaces Committee Opinion Number 460, July 2010, Reaffirmed 2016)

ABSTRACT: The initial visit for screening and the provision of reproductive preventive health care services and guidance should take place between the ages of 13 years and 15 years. The initial reproductive health visit provides an excellent opportunity for the obstetrician–gynecologist to start a patient–physician relationship, build trust, and counsel patients and parents regarding healthy behavior while dispelling myths and fears. The scope of the initial reproductive health visit will depend on the individual’s need, medical history, physical and emotional development, and the level of ca...


Committee Opinion Number 385, November 2007

Reaffirmed 2016

ABSTRACT: Health care providers occasionally may find that providing indicated, even standard, care would present for them a personal moral problem—a conflict of conscience—particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient's health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be a...


Committee Opinion Number 657, February 2016

(Replaces Committee Opinion Number 459, July 2010)

ABSTRACT: The term “hospitalist” refers to physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities may include patient care, teaching, research, and inpatient leadership. The American College of Obstetricians and Gynecologists supports the continued development and study of the obstetric and gynecologic (ob-gyn) hospitalist model as one potential approach to improve patient safety and professional satisfaction across delivery settings. Effective patient handoffs, updates on progress, and clear follow-up instructions between ob-gyn hos...


Committee Opinion Number 440, August 2009

(Reaffirmed 2015)

ABSTRACT: The clinical approach to postmenopausal bleeding requires prompt and efficient evaluation to exclude or diagnose carcinoma. Women with postmenopausal bleeding may be assessed initially with either endometrial biopsy or transvaginal ultrasonography; this initial evaluation does not require performance of both tests. Transvaginal ultrasonography can be useful in the triage of patients in whom endometrial sampling was performed but tissue was insufficient for diagnosis. When transvaginal ultrasonography is performed for patients with postmenopausal bleeding and an endometrial thickness...


Committee Opinion Number 477, March 2011

(Replaces No. 280, December 2002)

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 ...


Committee Opinion Number 626, March 2015

ABSTRACT: Young women (aged 18–26 years) are a heterogeneous population transitioning from adolescence into adulthood who may present with unique issues and challenges, including a potential gap in health care after pediatric health care. Obstetrician–gynecologists should note that these patients may need assistance in transitioning from a pediatrician to a provider of adult health care (an internist, family practitioner, or obstetrician–gynecologist), especially in the absence of a parent. Preventive counseling is crucial for helping young women anticipate changes and stressors and for easin...


Committee Opinion Number 659, March 2016

ABSTRACT: Cancer treatment should address female-specific survivorship issues, including the hypoestrogenic-related adverse effects of cancer therapies or of natural menopause in survivors. Systemic and vaginal estrogen are widely used for symptomatic relief of vasomotor symptoms, sexual dysfunction, and lower urinary tract infections in the general population. However, given that some types of cancer are hormone sensitive, there are safety concerns about the use of local hormone therapy in women who currently have breast cancer or have a history of breast cancer. Nonhormonal approaches are t...


193.
September 2011

Committee Opinion Number 503, September 2011

(Reaffirmed 2015)

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 obstetrici...


194.
December 2012

Committee Opinion Number 546, December 2012

(Reaffirmed 2016. Replaces No. 461, August 2010)

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.


Committee Opinion Number 205, August 1998

Tubal ligation at the time of cesarean delivery requires significant additional physician work even though the technical work of the procedure is brief. Informed consent by the patient requires considerably more counseling by the physician regarding potential risks and benefits of this procedure than is necessary with alternative means of sterilization and contraception. Also, many states require completion of special informed consent documents in addition to the customary consent forms required by hospitals. These forms must be completed before scheduling the procedure.


196.
December 2015

Committee Opinion Number 648, December 2015

(Replaces Committee Opinion Number 399, February 2008)

ABSTRACT: Once considered a waste product that was discarded with the placenta, umbilical cord blood is now known to contain potentially life-saving hematopoietic stem cells. When used in hematopoietic stem cell transplantation, umbilical cord blood offers several distinct advantages over bone marrow or peripheral stem cells. However, umbilical cord blood collection is not part of routine obstetric care and is not medically indicated. Umbilical cord blood collection should not compromise obstetric or neonatal care or alter routine practice for the timing of umbilical cord clamping. If a patie...


Committee Opinion Number 566, June 2013

(Replaces No. 521, March 2012, Reaffirmed 2016)

ABSTRACT: In the face of dramatic and persistent increases in pertussis disease in the United States, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices has updated its guidelines for the use of the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) for pregnant women. The new guidance was issued based on an imperative to minimize the significant burden of pertussis disease in vulnerable newborns, the reassuring safety data on the use of Tdap in adults, and the evolving immunogenicity data that demonstrate considerable w...


Committee Opinion Number 378, September 2007

Reaffirmed 2016

ABSTRACT: So-called "vaginal rejuvenation," "designer vaginoplasty," "revirgination," and "G-spot amplification" are vaginal surgical procedures being offered by some practitioners. These procedures are not medically indicated, and the safety and effectiveness of these procedures have not been documented. Clinicians who receive requests from patients for such procedures should discuss with the patient the reason for her request and perform an evaluation for any physical signs or symptoms that may indicate the need for surgical intervention. Women should be informed about the lack of data supp...


Committee Opinion Number 495, July 2011

(Reaffirmed 2015)

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 pregn...


200.
December 2013

Committee Opinion Number 580, December 2013

(Replaces No. 451, December 2009, Reaffirmed 2015)

ABSTRACT: Von Willebrand disease, the most common inherited bleeding disorder among American women, is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Von Willebrand disease and other inherited and acquired disorders of coagulation and hemostasis should be considered in the differential diagnosis of all patients being evaluated for heavy menstrual bleeding, regardless of age. There are many treatment options available for patients with von Willebrand disease and heavy menstrual bleeding, including hormonal and nonhormonal therapies. A mult...


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