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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...


44.
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.


45.
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 ...


47.
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


49.
January 2019

Number 8, January 2019

ABSTRACT: Interpregnancy care aims to maximize a woman’s level of wellness not just in between pregnancies and during subsequent pregnancies, but also along her life course. Because the interpregnancy period is a continuum for overall health and wellness, all women of reproductive age who have been pregnant regardless of the outcome of their pregnancies (ie, miscarriage, abortion, preterm, full-term delivery), should receive interpregnancy care as a continuum from postpartum care. The initial components of interpregnancy care should include the components of postpartum care, such as reproduct...


Committee Opinion Number 761, January 2019

(Replaces Committee Opinion No. 559, April 2013)

ABSTRACT: The incidence of cesarean delivery on maternal request and its contribution to the overall increase in the cesarean delivery rate are not well known, but it is estimated that 2.5% of all births in the United States are cesarean delivery on maternal request. Cesarean delivery on maternal request is not a well-recognized clinical entity. The available information that compared the risks and benefits of cesarean delivery on maternal request and planned vaginal delivery does not provide the basis for a recommendation for either mode of delivery. When a woman desires a cesarean delivery ...


Practice Bulletin Number 202, January 2019

Members Only


52.
December 2018

Number 7, December 2018

(Replaces Committee Opinion No. 529, July 2012)

ABSTRACT: Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. The most favored hypothesis regarding the etiology of placenta accreta spectrum is that a defect of the endometrial–myometrial interface leads to a failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration. Maternal morbidity and mortality can occur because of severe and sometimes life-threaten...


Committee Opinion Number 760, December 2018

ABSTRACT: Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology. When the patient’s history suggests primary dysmenorrhea, empiric treatment should be initiated. When a patient does not experience clinical improvement for her dysmenorrhea within 3–6 months of therapy initiation, her obstetrician–gynecologist should investigate for possible secondary causes and for treatment adherence. Secondary dysmenor...


Practice Bulletin Number 201, December 2018

(Replaces Practice Bulletin Number 60, March 2005)

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Committee Opinion Number 759, November 2018

(Replaces Committee Opinion No. 466, September 2010)

ABSTRACT: Global surgical care programs present obstetrician–gynecologists with important opportunities to address disparities in women’s health and health care worldwide. However, these programs also present a unique set of practical and ethical challenges. Obstetrician–gynecologists are encouraged to participate in surgical care efforts abroad while taking the necessary steps to ensure that their patients can make informed decisions and receive benefit from and are not harmed by their surgical care. In this document, the Committee on Ethics highlights some of the ethical issues that may ari...


Committee Opinion Number 758, November 2018

ABSTRACT: Obstetrician–gynecologists have the opportunity to promote healthy relationships by encouraging adolescents to discuss past and present relationships while educating them about respect for themselves and mutual respect for others. Because middle school is a time when some adolescents may develop their first romantic or sexual relationships, it is an ideal timeframe for obstetrician–gynecologists and other health care providers, parents, and guardians to play a role in anticipatory guidance. Creating a nonjudgmental environment and educating staff on the unique concerns of adolescent...


Committee Opinion Number 757, November 2018

(Replaces Committee Opinion No. 630, May 2015)

ABSTRACT: Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects. Several screening instruments have been validated for use during pregnancy and the postpartum period. The American College of Obstetricians and Gynecologist...


58.
November 2018

Practice Bulletin Number 200, November 2018

(Replaces Practice Bulletin Number 150, May 2015)

Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management. The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss.


Members Only


Committee Opinion Number 756, October 2018

(Replaces Committee Opinion Number 658, February 2016)

ABSTRACT: As reproductive health experts and advocates for women’s health who work in conjunction with other obstetric and pediatric health care providers, obstetrician–gynecologists are uniquely positioned to enable women to achieve their infant feeding goals. Maternity care policies and practices that support breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during prenatal care, during their maternity stay, and after the birth occurs. Enabling women to breastfeed is a public health priority because, on a populatio...


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