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1.
February 2018

Practice Bulletin Number 191, February 2018

Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely d...


Practice Bulletin Number 190, February 2018

(Replaces Practice Bulletin Number 180, July 2017)

Members Only


3.
February 2018

Committee Opinion Number 730, February 2018

(Replaces Committee Opinion No. 519, March 2012)

Abstract: Fatigue and sleep deprivation may affect a health care provider’s skills and communication style, and also may affect clinical outcomes. The National Sleep Foundation recommends 7–9 hours of sleep per night for an adult. However, there are no current guidelines limiting the volume of deliveries and procedures performed by a single individual or on the length of time he or she may be on call. Medical literature has shown that even a single night of missed sleep measurably affects cognitive performance. When adults do not sleep at least 5 hours per night, language and numeric skills...


The Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) have released updated guidance on preventing the transmission of hepatitis B virus (HBV) infection.


On December 7, 2017, a cohort study analyzing the risk of invasive breast cancer in women who used hormonal contraception was published in the New England Journal of Medicine. The study was designed to assess the influence of hormonal contraceptive use on the development of cardiovascular disease and cancer in a national cohort of Danish women.


Committee Opinion Number 729, January 2018

(Replaces Committee Opinion Number 493, May 2011)

ABSTRACT: Awareness of the broader contexts that influence health supports respectful, patient-centered care that incorporates lived experiences, optimizes health outcomes, improves communication, and can help reduce health and health care inequities. Although there is little doubt that genetics and lifestyle play an important role in shaping the overall health of individuals, interdisciplinary researchers have demonstrated how the conditions in the environment in which people are born, live, work, and age, play equally as important a role in shaping health outcomes. These factors, referred t...


Practice Bulletin Number 189, January 2018

(Replaces Practice Bulletin 153, September 2015)

Members Only


Committee Opinion Number 728, January 2018

(Replaces Committee Opinion Number 562, May 2013)

ABSTRACT: Müllerian agenesis, also referred to as müllerian aplasia, Mayer-Rokitansky-Küster-Hauser syndrome, or vaginal agenesis, has an incidence of 1 per 4,500–5,000 females. Müllerian agenesis is caused by embryologic underdevelopment of the müllerian duct, with resultant agenesis or atresia of the vagina, uterus, or both. Patients with müllerian agenesis usually are identified when they are evaluated for primary amenorrhea with otherwise typical growth and pubertal development. The most important steps in the effective management of müllerian agenesis are correct diagnosis of the underly...


Practice Bulletin Number 188, January 2018

(Replaces Practice Bulletin Number 172, October 2016)

Members Only


Committee Opinion Number 727, January 2018

ABSTRACT: “Cascade testing” refers to the performance of genetic counseling and testing in blood relatives of individuals who have been identified with specific genetic mutations. Testing protocols and other interventions may save lives and improve health and quality of life for these family members. Obstetrician–gynecologists should know who is eligible for cascade testing and should use all available resources to ensure that cascade testing is offered and occurs in a timely manner. Despite the clear health benefits for specific populations and individuals, obstetrician–gynecologists should ...


11.
December 2017

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12.
December 2017

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On December 14, 2017, the Agency for Healthcare Research and Quality (AHRQ) released a comparative effectiveness review on the management of uterine fibroids. The AHRQ’s systematic review of the literature includes analysis of randomized control trial data on the effectiveness of interventions for reducing leiomyoma size and improving a patient’s symptoms and quality of life. The report also includes data on the risk of encountering a leiomyosarcoma at the time of surgery for presumed leiomyomas.


16.
December 2017

Practice Bulletin Number 187, December 2017

(Replaces Practice Bulletin Number 44, July 2003)

Members Only


Committee Opinion Number 726, December 2017

(Replaces Committee Opinion Number 555, March 2013)

ABSTRACT: Large-scale catastrophic events and infectious disease outbreaks highlight the need for disaster planning at all community levels. Features unique to the obstetric population (including antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods an...


In evaluating all the available scientific information, the results from the September 2017 study do not warrant changing the current recommendation. Influenza vaccination remains the best available prevention for serious morbidity related to flu in pregnancy.


If these medications are used, obstetrician-gynecologists should be aware of the benefits and risks associated with these medications, including the updated information based on the FDA Safety Communication.


Practice Bulletin Number 186, November 2017

(Replaces Practice Bulletin Number 121, July 2011)

Intrauterine devices and contraceptive implants, also called long-acting reversible contraceptives (LARC), are the most effective reversible contraceptive methods. The major advantage of LARC compared with other reversible contraceptive methods is that they do not require ongoing effort on the part of the patient for long-term and effective use. In addition, after the device is removed, the return of fertility is rapid (1, 2). The purpose of this Practice Bulletin is to provide information for appropriate patient selection and evidence-based recommendations for LARC initiation and management....


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