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Committee Opinion Number 410, June 2008

(Reaffirmed 2014)

ABSTRACT: Genetic testing is poised to play an increasing role in the practice of obstetrics and gynecology. To assure patients of the highest quality of care, physicians should become familiar with the currently available array of genetic tests and the tests' limitations. Clinicians should be able to identify patients within their practices who are candidates for genetic testing. Candidates will include patients who are pregnant or considering pregnancy and are at risk for giving birth to affected children as well as gynecology patients who, for example, may have or be predisposed to certain...


Committee Opinion Number 578, November 2013

(Reaffirmed 2016. Replaces No. 395, January 2008)

ABSTRACT: Acknowledgment of the importance of patient autonomy and increased patient access to information, such as information on the Internet, has prompted more patient-generated requests for surgical interventions not traditionally recommended. Depending on the context, acceding to a request for a surgical option that is not traditionally recommended can be ethical. Decisions about acceding to patient requests for nontraditional surgical interventions should be based on strong support for patients’ informed preferences and values; understood in the context of an interpretive conversation; ...


Committee Opinion Number 564, May 2013

(Reaffirmed 2016)

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...


5.
December 2007

Committee Opinion Number 389, December 2007

(Reaffirmed 2015)

ABSTRACT: Because human immunodeficiency virus (HIV) infection often is detected through prenatal and sexually transmitted disease testing, an obstetrician–gynecologist may be the first health professional to provide care for a woman infected with HIV. Universal testing with patient notification and right of refusal ("opt-out" testing) is recommended by most national organizations and federal agencies. Although opt-out and "opt-in" testing (but not mandatory testing) are both ethically acceptable, the former approach may identify more women who are eligible for therapy and may have public hea...


Committee Opinion Number 664, June 2016

(Replaces Committee Opinion Number 321, November 2005)

ABSTRACT: One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus’s well-being, or both. In such circumstances, the obstetrician–gynecologist’s ethical obligation to safeguard the pregnant woman’s autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance—the alternative to respecting a patient’s refusal of treatment—raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power diffe...


Committee Opinion Number 660, March 2016

(Replaces Committee Opinion No. 397, February 2008)

ABSTRACT: Gestational surrogacy is an increasingly common form of family building that can allow individuals or a couple to become parents despite circumstances in which carrying a pregnancy is biologically impossible or medically contraindicated. The practice of gestational surrogacy involves a woman known as a gestational carrier who agrees to bear a genetically unrelated child with the help of assisted reproductive technologies for an individual or couple who intend(s) to be the legal and rearing parent(s), referred to as the intended parent(s). Obstetrician–gynecologists may become involv...


Committee Opinion Number 501, August 2011

(Reaffirmed 2017)

ABSTRACT: The past two decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and t...


9.
September 2017

Committee Opinion Number 719, September 2017

(Replaces Committee Opinion Number 553, February 2013)

ABSTRACT: Although not all multifetal pregnancies occur after the use of assisted reproductive technology, fertility treatments have contributed significantly to the increase in multifetal pregnancies. In almost all cases, it is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos to be transferred or by cancelling a gonadotropin cycle when the ovarian response suggests a high risk of a multifetal pregnancy. When multifetal pregnancies do occur, incorporating the ethical framework presented in this Committee Opinion will help obstetrician–gynecol...


10.
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 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 681, December 2016

(Replaces Committee Opinion No. 520, March 2012)

ABSTRACT: Adverse outcomes, preventable or otherwise, are a reality of medical care. Most importantly, adverse events affect patients, but they also affect health care practitioners. Disclosing information about adverse events has benefits for the patient and the physician and, ideally, strengthens the patient–physician relationship and promotes trust. Studies show that after an adverse outcome, patients expect and want timely and full disclosure of the event, an acknowledgment of responsibility, an understanding of what happened, expressions of sympathy, and a discussion of what is being don...


Committee Opinion Number 680, November 2016

ABSTRACT: Checklists are used in medical and nonmedical settings as cognitive aids to ensure that users complete all the items associated with a particular task. They are ideal for tasks with many steps, for tasks performed under stressful circumstances, or for reminding people to perform tasks that they are not routinely accustomed to doing. In medicine, they are ideal for promoting standardized processes of care in situations in which variation in practice may increase patient risk and the chance of medical errors. Checklists also can be used to enhance teamwork and communication. It is a g...


Committee Opinion Number 639, September 2015

(Reaffirmed 2017)

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;...


15.
February 2012

Committee Opinion Number 518, February 2012

ABSTRACT: Intimate partner violence (IPV) is a significant yet preventable public health problem that affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background. Individuals who are subjected to IPV may have lifelong consequences, including emotional trauma, lasting physical impairment, chronic health problems, and even death. Although women of all ages may experience IPV, it is most prevalent among women of reproductive age and contributes to gynecologic disorders, pregnancy complications, unintended pregnancy, and s...


Committee Opinion Number 627, March 2015

(Replaces Committee Opinion Number 425, January 2009, Reaffirmed 2017)

ABSTRACT: Unauthorized (undocumented) immigrants are less likely than other residents of the United States to have health insurance. The American College of Obstetricians and Gynecologists has long supported a basic health care package for all women living within the United States without regard to their country of origin or documentation. Providing access to quality health care for unauthorized immigrants and their children, who often were born in the United States and have U.S. citizenship, is essential to improving the nation’s public health.


Committee Opinion Number 498, August 2011

(Reaffirmed 2017)

ABSTRACT: Long-term effects of childhood sexual abuse are varied, complex, and often devastating. Many obstetrician-gynecologists knowingly or unknowingly provide care to abuse survivors and should screen all women for a history of such abuse. Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse. Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, nonspecific vaginitis, and gastrointestinal disorders are common diagnoses among survivors. Survivors may be less likely to have regular Pap tests and may seek little o...


Committee Opinion Number 569, August 2013

(Reaffirmed 2017)

ABSTRACT: Oral health is an important component of general health and should be maintained during pregnancy and through a woman’s lifespan. Maintaining good oral health may have a positive effect on cardiovascular disease, diabetes, and other disorders. In 2007–2009, 35% of U.S. women reported that they did not have a dental visit within the past year and 56% of women did not visit a dentist during pregnancy. Access to dental care is directly related to income level; the poorest women are least likely to have received dental care. Optimal maternal oral hygiene during the perinatal period may ...


Committee Opinion Number 511, November 2011

Reaffirmed 2016

ABSTRACT: Clinicians who provide care for incarcerated women should be aware of the special health care needs of pregnant incarcerated women and the specific issues related to the use of restraints during pregnancy and the postpartum period. The use of restraints on pregnant incarcerated women and adolescents may not only compromise health care but is demeaning and rarely necessary.


Committee Opinion Number 457, June 2010

(Reaffirmed 2016)

ABSTRACT: Emergency plans that specifically address the needs of women, infants, and children during disasters are currently underdeveloped in the United States. Pregnant women, infants, and children are adversely affected by disasters resulting in an increased number of infants with intrauterine growth restriction, low birth weight, and a small head circumference. There is an increased incidence of preterm delivery. To provide for a healthy pregnancy and delivery, pregnant women affected by disasters need to be assured of a continuation of prenatal care. Those in the third trimester should b...


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