Prevention of Early-Onset Group B Streptococcal Disease in Newborns

Committee Opinion Number 782, June 2019

(Replaces No. 485, April 2011)

ABSTRACT: Group B streptococcus (GBS) is the leading cause of newborn infection (1). The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1 – 2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, p...

Immune Modulating Therapies in Pregnancy and Lactation

Committee Opinion Number 776, April 2019

ABSTRACT: Because autoimmune conditions occur more often among women of childbearing age, continuation of these medications during pregnancy is often considered to optimize disease management in the woman and pregnancy outcomes, without placing the fetus at undue risk. Many commonly prescribed drugs can be used safely during pregnancy without risk of teratogenicity or pregnancy complications, whereas a few are strictly contraindicated. The decision to use any agent during pregnancy should be based on the clinical context, risks associated with individual medications, and gestational age. For ...

Nonobstetric Surgery During Pregnancy

Committee Opinion Number 775, April 2019

(Replaces Committee Opinion No. 696, April 2017)

ABSTRACT: The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice acknowledges that the issue of nonobstetric surgery during pregnancy is an important concern for physicians who care for women. Because of the difficulty of conducting large-scale randomized clinical trials in this population, there are no data to allow for specific recommendations. It is important for a physician to obtain an obstetric consultation before performing nonobstetric surgery and some invasive procedures (eg, cardiac catheterization or colonoscopy) because obstetricians are uniquely ...

Immunization Implementation Strategies for Obstetrician–Gynecologists

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...

Thrombocytopenia in Pregnancy

Practice Bulletin Number 207, March 2019

(Replaces Practice Bulletin Number 166, September 2016)

Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period

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...

Chronic Hypertension in Pregnancy

Practice Bulletin Number 203, January 2019

Gestational Hypertension and Preeclampsia

Practice Bulletin Number 202, January 2019

Pregestational Diabetes Mellitus

Practice Bulletin Number 201, December 2018

(Replaces Practice Bulletin Number 60, March 2005)

Assessment and Treatment of Pregnant Women With Suspected or Confirmed Influenza

Committee Opinion Number 753, October 2018

ABSTRACT: Pregnant and postpartum women are at high risk of serious complications of seasonal and pandemic influenza infection. Pregnancy itself is a high-risk condition, making the potential adverse effects of influenza particularly serious in pregnant women. If a pregnant woman has other underlying health conditions, the risk of adverse effects from influenza is even greater. Antiviral treatment is necessary for all pregnant women with suspected or confirmed influenza, regardless of vaccination status. Obstetrician–gynecologists and other obstetric care providers should promptly recognize t...

Use of Prophylactic Antibiotics in Labor and Delivery

Practice Bulletin Number 199, September 2018

(Replaces Practice Bulletin Number 120, June 2011)

Low-Dose Aspirin Use During Pregnancy

Committee Opinion Number 743, July 2018

ABSTRACT: Low-dose aspirin has been used during pregnancy, most commonly to prevent or delay the onset of preeclampsia. The American College of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin beginning in the late first trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than one prior pregnancy complicated by preeclampsia. The U.S. Preventive Services Task Force published a similar guideline, although the list of indications...

Inherited Thrombophilias in Pregnancy

Practice Bulletin Number 197, July 2018

(Replaces Practice Bulletin Number 138, September 2013)

Postpartum Pain Management

Committee Opinion Number 742, July 2018

ABSTRACT: Pain and fatigue are the most common problems reported by women in the early postpartum period. Pain can interfere with a woman’s ability to care for herself and her infant. Untreated pain is associated with a risk of greater opioid use, postpartum depression, and development of persistent pain. Nonpharmacologic and pharmacologic therapies are important components of postpartum pain management. Because 81% of women in the United States initiate breastfeeding during the postpartum period, it is important to consider the drug effects of all prescribed medications on the mother–infant ...

Thromboembolism in Pregnancy

Practice Bulletin Number 196, July 2018

(Replaces Practice Bulletin Number 123, August 2011)

Maternal Immunization

Committee Opinion Number 741, June 2018

ABSTRACT: Immunization is an essential part of care for adults, including pregnant women. Influenza vaccination for pregnant women is especially important because pregnant women who contract influenza are at greater risk of maternal morbidity and mortality in addition to fetal morbidity, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight. Other vaccines provide maternal protection from severe morbidity related to specific pathogens such as pneumococcus, meningococcus, and hepatitis for at-risk pregnant women. Obstetrician–gynecologists and other obstetri...

Influenza Vaccination During Pregnancy

Committee Opinion Number 732, April 2018

(Replaces Committee Opinion Number 608, September 2014)

ABSTRACT: Influenza vaccination is an essential element of prepregnancy, prenatal, and postpartum care because influenza can result in serious illness, including a higher chance of progressing to pneumonia, when it occurs during the antepartum or postpartum period. In addition to hospitalization, pregnant women with influenza are at increased risk of intensive care unit admission and adverse perinatal and neonatal outcomes. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the American College of Obstetricians and Gynecologists recommend that al...

Management of Alloimmunization During Pregnancy

Practice Bulletin Number 192, March 2018

(Replaces Practice Bulletin Number 75, August 2006) (Reaffirmed 2019)

Gestational Diabetes Mellitus

Practice Bulletin Number 190, February 2018

(Replaces Practice Bulletin Number 180, July 2017) (Reaffirmed 2019)

Nausea and Vomiting of Pregnancy

Practice Bulletin Number 189, January 2018

(Replaces Practice Bulletin 153, September 2015)