Practice Updates: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period, HPV Vaccination, Screening Pelvic Examination

Stay up to date with ACOG's authoritative clinical guidance and helpful patient education materials. The following provides Practice Updates for March and April 2017.


Featured ACOG Announcement: Labetalol Injection Shortage for Severe Hypertension

ASHP and are reporting a shortage of labetalol injection due to increased demand and manufacturing delays. This will likely impact the care of pregnant women and postpartum women with severe hypertension, as ACOG recommends intravenous (IV) labetalol as a first-line medication for the management of acute-onset, severe hypertension in these populations. However, immediate release oral nifedipine also may be considered as a first-line therapy, particularly when IV access is not available. If immediate released oral nifedipine is not available, a 200-mg dose of labetalol can be administered orally and repeated in 30 minutes if appropriate improvement is not observed.

Specifically, Akorn has labetalol 5 mg/mL 40 mL vials on back order, and the company estimates a release date of late-March 2017. The 20 mL vials are on allocation. Pfizer has labetalol 5 mg/mL 4 mL Carpuject syringes on back order and the company estimates a release date of early-March 2017. The 20 mL and 40 mL vials are on back order and the company estimates a release date of early-March 2017 for the 20 mL vials and early-April 2017 for the 40 mL vials.

For more information, see Committee Opinion 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period, available in the April 2017 issue of Obstetrics and Gynecology.

Featured Updated Committee Opinion 704: Human Papillomavirus Vaccination

This updated Committee Opinion stresses the importance of educating parents and patients on the benefits and safety of human papillomavirus (HPV) vaccination. The HPV vaccination significantly reduces the incidence of anogenital cancer and genital warts. The target age for HPV vaccination is 11–12 years for girls and boys, but the HPV vaccine can be given to both genders through 26 years of age. Testing for HPV DNA is not recommended before vaccination. Vaccination is recommended even if the patient is tested for HPV DNA and the results are positive. Obstetrician–gynecologists and other health care providers should counsel patients to expect mild local discomfort after the vaccination and that such discomfort is not a cause for concern. Adolescents should be observed for at least 15 minutes after vaccination because they are at higher risk of fainting.

Committee Opinion 704: Human Papillomavirus Vaccination will be available in the June 2017 issue of Obstetrics and Gynecology and is available now via publish ahead of print. It replaces Committee Opinion 641, September 2015.


Featured Practice Bulletin 176: Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a common, benign condition in women. For many women it can cause vaginal bulge and pressure, voiding dysfunction, defecatory dysfunction, and sexual dysfunction, which may adversely affect quality of life. The recommended initial evaluation for a woman with suspected POP includes a thorough history, assessment of symptom severity, physical examination, and goals for treatment. Symptom assessment is the most important part of the evaluation of a woman with POP.

Practice Bulletin 176: Pelvic Organ Prolapse is available in the April 2017 issue of Obstetrics and Gynecology.


Featured Practice Advisory: Screening Pelvic Examination

This Practice Advisory is based on a final recommendation statement and evidence summary from the US Preventive Services Task Force (USPSTF) on screening for gynecologic conditions with pelvic examination in women without any signs or symptoms. The USPSTF’s recommendation concluded that there is not enough evidence to determine the balance of benefits or harms of performing screening pelvic exams in asymptomatic, non-pregnant adult women. The Practice Advisory notes that this is not a recommendation against performing routine pelvic examinations, but encourages continued use of clinical judgement.

Read the full Practice Advisory: Screening Pelvic Examination, updated March 7, 2017.


Zika Information

ACOG’s Zika webpage

ACOG Zika Practice Advisory

ACOG Zika Toolkit, including patient education video, infographic, and assessment web tool endorsed by CDC

CDC’sPregnancy and Zika Testing Clinical Algorithm

CDC Zika Virus Website

State Health Department Contact list for ob-gyns (members only) for questions on CDC’s Zika Registry

State Health Department Contact list for ob-gyns (members only) for questions on testing

CDC Zika Pregnancy Hotline for Health Care Providers: Ob-gyns can contact the CDC Zika Pregnancy Hotline at 770-488-7100, or email for any concerns related to clinical management or the US Zika Pregnancy Registry

Office of Population Affairs' Zika Toolkit


New Committee Opinions


See all Committee Opinions


New Practice Bulletins (members only) 

See all Practice Bulletins

New Title: Clinical Updates in Women's Health Care (members only)

See all Clinical Updates Titles

New Patient Education Pamphlets (members only)

See all Patient Education Pamphlets

Frequently Asked Questions (FAQs) for Patients

See all Frequently Asked Questions


American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998