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Committee Opinion Number 565, June 2013

(Replaces No. 420, November 2008) (Reaffirmed 2018)

ABSTRACT: Menopausal hormone therapy should not be used for the primary or secondary prevention of coronary heart disease at the present time. Evidence is insufficient to conclude that long-term estrogen therapy or hormone therapy use improves cardiovascular outcomes. Nevertheless, recent evidence suggests that women in early menopause who are in good cardiovascular health are at low risk of adverse cardiovascular outcomes and should be considered candidates for the use of estrogen therapy or conjugated equine estrogen plus a progestin for relief of menopausal symptoms. There is some evidence...


Committee Opinion Number 564, May 2013

(Reaffirmed 2019)

ABSTRACT: Because of the growing importance of infectious disease prevention in the individual patient and the larger community, it is vital that Fellows of the American College of Obstetricians and Gynecologists be prepared to navigate the practical and ethical challenges that come with vaccination. Health care professionals have an ethical obligation to keep their patients’ best interests in mind by following evidence-based guidelines to encourage patients to be vaccinated and to be vaccinated themselves. College Fellows should counsel their patients about vaccination in an evidence-based m...


Committee Opinion Number 563, May 2013

(Reaffirmed 2016)

ABSTRACT: Pregnant women traditionally have been assigned priority in the allocation of prevention and treatment resources during outbreaks of influenza because of their increased risk of morbidity and mortality. The Committee on Ethics of the American College of Obstetricians and Gynecologists explores ethical justifications for assigning priority for prevention and treatment resources to pregnant women during an influenza pandemic, makes recommendations to incorporate ethical issues in pandemic influenza planning concerning pregnant women, and calls for pandemic preparedness efforts to incl...


Committee Opinion Number 557, April 2013

(Reaffirmed 2019)

ABSTRACT: Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabilization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system. Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on ...


Committee Opinion Number 556, April 2013

(Reaffirmed 2019)

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 554, February 2013

(Reaffirmed 2019)

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 552, January 2013

(Reaffirmed 2018)

ABSTRACT: Many U.S. women are uninsured and face avoidable adverse obstetric and gynecologic health outcomes. The Affordable Care Act requires an expansion of Medicaid that would increase the percentage of U.S. women with health insurance, with the anticipated benefit of improved health. The 2012 Supreme Court decision allows states to opt out of Medicaid expansion. The American College of Obstetricians and Gynecologists supports appropriate reimbursement to health care providers and the expansion of Medicaid as key strategies to improve women’s health.


Committee Opinion Number 551, January 2013

(Reaffirmed 2016. Replaces Committee Opinion Number 497, August 2011)

ABSTRACT: Obstetrician–gynecologists should recognize that being a defendant in a medical professional liability lawsuit can be one of life’s most stressful experiences. Negative emotions in response to a lawsuit are normal, and physicians may need help from family members, peers, or professionals to cope with this stress. Open communication will assist in reducing emotional isolation and self-blame. However, pertinent legal and clinical aspects of a case must be kept confidential, except for disclosure within the confines of a protected counselor–patient relationship as determined by state l...


189.
January 2013

Committee Opinion Number 548, January 2013

(Reaffirmed 2018)

ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less wei...


Committee Opinion Number 547, December 2012

(Reaffirmed 2019)

Abstract: Military service is associated with unique risks to women’s reproductive health. As increasing numbers of women are serving in the military, and a greater proportion of United States Veterans are women, it is essential that obstetrician–-gynecologists are aware of and well prepared to address the unique health care needs of this demographic group. Obstetrician–-gynecologists should ask about women’s military service, know the Veteran status of their patients, and be aware of high prevalence problems (eg, posttraumatic stress disorder, intimate partner violence, and military sexual t...


191.
December 2012

Committee Opinion Number 546, December 2012

(Replaces No. 461, August 2010) (Reaffirmed 2019)

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 541, November 2012

(Replaces No. 401, March 2008, Reaffirmed 2015)

ABSTRACT: The American College of Obstetricians and Gynecologists (the College) has a long history of leadership in ensuring that its educational mission is evidence based and unbiased. A predecessor to this Committee Opinion was published in 1985, making the College one of the first professional associations to provide guidance on this issue. The College has continued to update the ethical guidance on physician interactions with industry periodically. Obstetrician–gynecologists’ relationships with industry should be structured in a manner that will enhance, rather than detract from, their ob...


Committee Opinion Number 540, November 2012

(Reaffirmed 2018)

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 535, August 2012

(Reaffirmed 2019)

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 533, August 2012

(Reaffirmed 2018)

Abstract: Prenatal lead exposure has known adverse effects on maternal health and infant outcomes across a wide range of maternal blood lead levels. Adverse effects of lead exposure are being identified at lower levels of exposure than previously recognized in both children and adults. In 2010, the Centers for Disease Control and Prevention issued the first guidelines regarding the screening and management of pregnant and lactating women who have been exposed to lead.


Committee Opinion Number 532, August 2012

(Replaces No. 387, November 2007 and No. 322, November 2005) (Reaffirmed 2018)

ABSTRACT: Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effectiveness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an individualized preparation in response to a health care provider’s prescription to create a medication tailored to the specialized needs of an individual patient. The Women’s Health...


197.
August 2012

Committee Opinion Number 531, August 2012

(Reaffirmed 2016. Replaces No. 331, April 2006 and No. 400, March 2008)

ABSTRACT: Despite significant national attention, medical errors continue to pervade the U.S. health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches tha...


Committee Opinion Number 530, July 2012

(Reaffirmed 2018)

ABSTRACT: Postpartum tubal sterilization is one of the safest and most effective methods of contraception. Women who desire this type of sterilization typically undergo thorough counseling and informed consent during prenatal care and reiterate their desire for postpartum sterilization at the time of their hospital admission. Not all women who desire postpartum sterilization actually undergo the surgical procedure, and women with unfulfilled requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year. Potentially correctable barriers ...


199.
June 2012

Committee Opinion Number 528, June 2012

(Replaces No. 368, June 2007) (Reaffirmed 2018)

ABSTRACT: Obstetrician–gynecologists may find themselves at the center of adoption issues because of their expertise in the assessment and management of infertility, pregnancy, and childbirth. The lack of clarity about both ethical issues and legal consequences may create challenges for physicians. Therefore, the Committee on Ethics of the American College of Obstetricians and Gynecologists discusses ethical issues, proposes safeguards, and makes recommendations regarding the role of the physician in adoption.


Committee Opinion Number 525, May 2012

(Reaffirmed 2018)

ABSTRACT: Lesbians and bisexual women encounter barriers to health care that include concerns about confidentiality and disclosure, discriminatory attitudes and treatment, limited access to health care and health insurance, and often a limited understanding as to what their health risks may be. Health care providers should offer quality care to all women regardless of sexual orientation. The American College of Obstetricians and Gynecologists endorses equitable treatment for lesbians and bisexual women and their families, not only for direct health care needs, but also for indirect health car...


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