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Committee Opinion Number 772, March 2019

(Replaces Committee Opinion Number 661, April 2016)

ABSTRACT: Immunization against vaccine-preventable diseases is an essential component of women’s primary and preventive health care. Many studies have shown that a recommendation from an obstetrician–gynecologist or other health care provider for a vaccine is one of the strongest influences on patient acceptance. Obstetrician–gynecologists and other health care providers should develop a standard process for assessing and documenting the vaccination status of patients and for recommending and administering vaccines. If allowed by state law, obstetrician–gynecologists and other health care pro...


Committee Opinion Number 771, March 2019

(Replaces Committee Opinion Number 648, December 2015)

ABSTRACT: Since the first successful umbilical cord blood transplant in 1988, it has been estimated that more than 35,000 transplants have been performed in children and adults for the correction of inborn errors of metabolism, hematopoietic malignancies, and genetic disorders of the blood and immune system. Two types of banks have emerged for the collection and storage of umbilical cord blood: 1) public banks and 2) private banks. The benefits and limitations of public versus private umbilical cord blood banking should be reviewed with the patient because they serve different purposes. This ...


Committee Opinion Number 770, March 2019

ABSTRACT: Morcellation is a surgical technique used to reduce the size of the uterus or myomas by creating smaller pieces to allow the tissue to be removed through small incisions or with laparoscopic instruments. Open (uncontained) morcellation of the uterus and myomas has been scrutinized because of the possible spread of an unsuspected leiomyosarcoma while using a power morcellator during a hysterectomy or myomectomy for presumed symptomatic uterine leiomyomas. Before considering open morcellation of the uterus, a woman should be evaluated to determine if she is at increased risk of malign...


Practice Bulletin Number 209, March 2019

(Replaces Practice Bulletin Number 177, April 2017)

Members Only


Committee Opinion Number 769, March 2019

(Replaces Committee Opinion No. 537, October 2012)

ABSTRACT: The reprocessing and reuse of single-use instruments has become increasingly common. Although there are limited data on reprocessed single-use devices, existing studies have found a significant rate of physical defects, performance issues, or improper decontamination. There are currently no data in the medical literature of studies evaluating the cost-effectiveness of reprocessed single-use devices in gynecologic surgery. The use of a reprocessed single-use device provides no direct benefit to an individual patient or her physician. It is the operating surgeon’s ethical responsibili...


Practice Bulletin Number 208, March 2019

(Replaces Practice Bulletin Number 133, February 2013)

Members Only


Practice Bulletin Number 207, March 2019

(Replaces Practice Bulletin Number 166, September 2016)

Members Only


Committee Opinion Number 768, March 2019

ABSTRACT: As adolescents with a genetic syndrome transition to adult medical care, they may be referred to obstetrician–gynecologists for routine preventive or contraceptive services, screening, or counseling for sexually transmitted infection, or for menstrual management. Although some genetic syndromes have no physical or intellectual impairment, others have significant ones; therefore, education and gynecologic care should be based on a patient’s intellectual and physical capabilities. It is important to remember that adolescents with or without a genetic syndrome are sexual beings. Thus, ...


This Practice Advisory focuses on the use of cell-free DNA screening technology specifically for identification of single-gene disorders.


Committee Opinion Number 767, February 2019

(Replaces Committee Opinion Number 692, September 2017)

ABSTRACT: Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to...


Practice Bulletin Number 206, February 2019

Members Only


Committee Opinion Number 766, February 2019

(Replaces Committee Opinion No. 687, February 2017)

ABSTRACT: Obstetrician–gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the la...


Committee Opinion Number 765, February 2019

(Replaces Committee Opinion No. 561, April 2013)

ABSTRACT: There are medical indications in pregnancy for which there is evidence or expert opinion to support delivery versus expectant management in the early-term period. However, the risk of adverse outcomes is greater for neonates delivered in the early-term period compared with neonates delivered at 39 weeks of gestation. In addition to immediate adverse perinatal outcomes, multiple studies have shown increased rates of adverse long-term infant outcomes associated with late-preterm and early-term delivery compared with full-term delivery. A recent systematic review found that late-preter...


Practice Bulletin Number 205, February 2019

(Replaces Practice Bulletin Number 184, August 2010)

Members Only


Committee Opinion Number 764, February 2019

(Replaces Committee Opinion No. 560, April 2013)

ABSTRACT: The neonatal risks of late-preterm and early-term births are well established, and the potential neonatal complications associated with elective delivery at less than 39 0/7 weeks of gestation are well described. However, there are a number of maternal, fetal, and placental complications in which either a late-preterm or early-term delivery is warranted. The timing of delivery in such cases must balance the maternal and newborn risks of late-preterm and early-term delivery with the risks associated with further continuation of pregnancy. Deferring delivery to the 39th week is not re...


16.
February 2019

Statement of Policy (Approved by the Executive Board February 2014) (Reaffirmed February 2019), February 2019

The impact of gun violence on the health and safety of women is of great concern to obstetrician– gynecologists. Women disproportionately experience intimate partner violence, and the presence of firearms within those relationships is a key risk factor for intimate partner homicide. Homicide is the second leading cause of injury-related deaths among pregnant and postpartum women, and the majority of these homicides are carried out with firearms.


17.
February 2019

Practice Bulletin Number 204, February 2019

(Replaces Practice Bulletin No. 134, May 2013) (Reaffirmed 2019)

Members Only


Committee Opinion Number 763, January 2019

(Replaces Committee Opinion Number 600, June 2014)

ABSTRACT: Obesity is a medical condition that may be associated with bias among health care professionals, and this bias may result in disrespectful or inadequate care of patients with obesity. Obstetrician–gynecologists regularly care for patients with obesity and play an integral role in advocating for best practices in health care and optimizing health outcomes for patients with obesity. Obstetrician–gynecologists should be prepared to care for their patients with obesity in a nonjudgmental manner, being cognizant of the medical and societal implications of obesity. This Committee Opinion ...


19.
January 2019

Committee Opinion Number 762, January 2019

ABSTRACT: The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by working with the woman to optimize health, address modifiable risk factors, and provide education about healthy pregnancy. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals. Counseling can begin with the following question: “Would you like to become pregnant in the next year?” Prepregnancy counseling is appropriate whether the reprodu...


Practice Bulletin Number 203, January 2019

Members Only


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