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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 ...


Committee Opinion Number 346, October 2006

(Reaffirmed 2018)

ABSTRACT: Amnioinfusion has been advocated as a technique to reduce the incidence of meconium aspiration and to improve neonatal outcome. However, a large proportion of women with meconium-stained amniotic fluid have infants who have taken in meconium within the trachea or bronchioles before meconium passage has been noted and before amnioinfusion can be performed by the obstetrician; meconium passage may predate labor. Based on current literature, routine prophylactic amnioinfusion for the dilution of meconium-stained amniotic fluid is not recommended. Prophylactic use of amnioinfusion for m...


Committee Opinion Number 713, August 2017

(Replaces Committee Opinion No. 677, October 2016) (Reaffirmed 2018)

ABSTRACT: Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including for those with ruptured membranes and multiple gestations. It also may be considered for pregnant women starting at 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days, based on a family’s decision regarding resuscitation, irrespecti...


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...


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 203, January 2019

Members Only


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...


Committee Opinion Number 678, November 2016

(Reaffirmed 2018)

ABSTRACT: Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition...


Practice Bulletin Number 211, May 2019

(Replaces Practice Bulletin Number 170, October 2016)

Members Only


11.
November 2013

Committee Opinion Number 579, November 2013

(Reaffirmed 2019)

ABSTRACT: In the past, the period from 3 weeks before until 2 weeks after the estimated date of delivery was considered “term,” with the expectation that neonatal outcomes from deliveries in this interval were uniform and good. Increasingly, however, research has shown that neonatal outcomes, especially respiratory morbidity, vary depending on the timing of delivery within this 5-week gestational age range. To address this lack of uniformity, a work group was convened in late 2012, which recommended that the label “term” be replaced with the designations early term (37 0/7 weeks of gestation ...


Committee Opinion Number 684, January 2017

(Replaces Committee Opinion Number 543, December 2012) (Reaffirmed 2018)

ABSTRACT: Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in jaundice that requires phototherapy in this group of infants. Consequently, health care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor for and treat neonatal jaundice. In preterm infants, de...


Committee Opinion Number 689, March 2017

(Reaffirmed 2019)

ABSTRACT: In 2006, the American Academy of Pediatrics and the American Heart Association published the 2005 guidelines on neonatal resuscitation. Before the 2005 guidelines, management of a newborn with meconium-stained amniotic fluid included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders. The 2005 guidelines did not support this practice because routine intrapartum suctioning does not prevent or alter the course of meconium aspiration syndrome in vigorous newborns. However, the 2005 guidelines did support ...


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...


15.
February 2016

Practice Bulletin Number 161, February 2016

(Replaces Practice Bulletin Number 13, February 2000) (Reaffirmed 2018)

Members Only


16.
November 2016

Practice Bulletin Number 173, November 2016

(Replaces Practice Bulletin Number 22, November 2000) (Reaffirmed 2018)

Members Only


Practice Bulletin Number 202, January 2019

Members Only


18.
March 2018

Committee Opinion Number 731, March 2018

ABSTRACT: Individual prenatal care is intended to prevent poor perinatal outcomes and provide education to women throughout pregnancy, childbirth, and the postpartum period through a series of one-on-one encounters between a woman and her obstetrician or other obstetric care provider. Concerns regarding increasing health care costs, health care provider availability, dissatisfaction with wait times, and the minimal opportunity for education and support associated with the individual care model have given rise to interest in alternative models of prenatal care. One alternative model, group pre...


19.
September 2017

Members Only


Committee Opinion Number 511, November 2011

(Reaffirmed 2019)

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.


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