Practice Updates: Long-Acting Reversible Contraception, Vaginal Birth After Cesarean Delivery, Zika

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


Featured Committee Opinion 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices

Updates to the ACOG Practice Bulletin reflect new key data on the safety of long-acting reversible contraception (LARC). Patients can choose from five different intrauterine devices (IUDs), the non-hormonal copper IUD or four different levonorgestrel containing IUDs, each with varying levels of hormone. The Practice Bulletin reviews evidence on the safety and efficacy of each of the devices, how they function to prevent pregnancy and their duration of effectiveness. More options make it easier for patients to find an IUD or implant suited to their needs. The Practice Bulletin provides detailed guidance about the best timing for initiating LARC, and in what circumstances a patient should be advised to use backup contraception.

The Practice Bulletin and other ACOG guidance identify contraception as an essential part of women’s health care based on scientific research and clinical expertise. LARC remains among the safest and most effective contraceptive methods available to women.

Practice Bulletin #186, Long-Acting Reversible Contraception: Implants and Intrauterine Devices is available in the November issue of Obstetrics & Gynecology.

Featured Practice Bulletin 184: Vaginal Birth After Cesarean Delivery

Updated guidance from ACOG specifies that Vaginal Birth After Cesarean Delivery (VBAC) should be attempted at maternal care facilities that typically manage uncomplicated births if they are capable of performing emergency deliveries. VBAC allows women to avoid major abdominal surgery and lowers their risk of hemorrhage, blood clots and infection. It also shortens the recovery period and reduces women’s risk of experiencing maternal morbidity or mortality during delivery in a future pregnancy due to repeated C-sections.

“ACOG’s recommendation is not meant to increase restrictions but instead ensure all women who want to attempt to undergo labor after a cesarean are in the appropriate facility to achieve positive outcomes,” said Mark Turrentine, MD, chair of ACOG’s Committee on Practice Bulletins-Obstetrics. “If the necessary resources aren’t available, obstetric care providers and patients need to discuss alternative options early in the course of antenatal care, including a transfer to another facility. However, this absolutely should not result in women having limited access to VBAC.”

Practice Bulletin 184: Vaginal Birth After Cesarean Delivery is available in the November 2017 issue of Obstetrics & Gynecology.


Featured Practice Advisory: Interim Guidance for Care of Obstetrics Patients During a Zika Virus Outbreak

Several sections of the joint ACOG and Society for Maternal-Fetal Medicine Zika Practice Advisory have been revised, based on updated guidance from the Centers for Disease Control and Prevention. This includes relevant updated guidance on ultrasound, amniocentesis, and the management and care of infants with possible Zika infection. Sections of the Practice Advisory that should be reviewed include Clinical Management of a Pregnant Woman with Suspected Zika Virus Infection, Neonatal Outcomes and Evaluation and References.

Read the full Practice Advisory, Interim Guidance for Care of Obstetrics Patients During a Zika Virus Outbreak, updated October 26, 2017

Zika Information

ACOG’s Zika webpage

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

CDC’s Pregnancy 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 and 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


Obstetric Care Consensus Series

See all Obstetric Care Consensus Documents


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

See all Clinical Updates Titles


New & Recently Updated 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