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Committee Opinion Number 724, November 2017

(Replaces Committee Opinion Number 409, June 2008;
Committee Opinion Number 488, May 2011;
and Committee Opinion Number 527, June 2012)

ABSTRACT: With the increased emphasis on patient-driven health care and readily available access to patients through the internet and media, many genetic testing companies have begun to market directly to consumers. Direct-to-consumer genetic testing raises unique concerns and considerations, including limited knowledge among patients and health care providers of available genetic tests, difficulty in interpretation of genetic test results, lack of oversight of companies that offer genetic testing, and issues of privacy and confidentiality. When undergoing any direct-to-consumer genetic testi...


2.
September 2017

Committee Opinion Number 719, September 2017

(Replaces Committee Opinion Number 553, February 2013)

ABSTRACT: Although not all multifetal pregnancies occur after the use of assisted reproductive technology, fertility treatments have contributed significantly to the increase in multifetal pregnancies. In almost all cases, it is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos to be transferred or by cancelling a gonadotropin cycle when the ovarian response suggests a high risk of a multifetal pregnancy. When multifetal pregnancies do occur, incorporating the ethical framework presented in this Committee Opinion will help obstetrician–gynecol...


Committee Opinion Number 709, August 2017

(Replaces Committee Opinion Number 359, January 2007)

ABSTRACT: Monetary reimbursement of physicians in exchange for medical advice and treatment is well established and accepted in medical practice. However, financial pressures and the pervasiveness of entrepreneurial values have led some physicians to widen the scope of activities for which they seek reimbursement. Some of these commercial activities are ethically problematic in the clinical setting. Obstetrician–gynecologists should strive to ensure that commercial enterprises in medical practice do not compromise the patient-focused mission of clinical care. In this Committee Opinion, the Am...


Committee Opinion Number 695, April 2017

(Replaces Committee Opinion Number 371, July 2007)

ABSTRACT: Sterilization is the most common method of contraception among married couples, with nearly twice as many couples choosing female partner sterilization over male sterilization. Although sterilization is among the most straightforward surgical procedures an obstetrician–gynecologist performs, it is enormously complex when considered from a historical, sociological, or ethical perspective. Sterilization practices have embodied a problematic tension, in which some women who desired fertility were sterilized without their knowledge or consent, and other women who wanted sterilization to...


Committee Opinion Number 691, March 2017

(Replaces Committee Opinion Number 318, October 2005;
Committee Opinion Number 432, May 2009;
Committee Opinion Number 442, October 2009;
Committee Opinion Number 469, October 2010;
Committee Opinion Number 486, April 2011)

ABSTRACT: Carrier screening is a term used to describe genetic testing that is performed on an individual who does not have any overt phenotype for a genetic disorder but may have one variant allele within a gene(s) associated with a diagnosis. Information about carrier screening should be provided to every pregnant woman. Carrier screening and counseling ideally should be performed before pregnancy because this enables couples to learn about their reproductive risk and consider the most complete range of reproductive options. A patient may decline any or all screening. When an individual is ...


6.
February 2017

(Approved February 2017)

There is a growing body of literature that validates the public health impact of racial bias, implicit and explicit, on the lives and health of people of color. As women’s health care physicians, obstetrician-gynecologists (ob-gyns) must work to clearly understand the impact of racial bias and how it manifests in our lives and in the lives of our patients. Racial bias is an issue that affects our patients, either directly by subjecting them or their families to inequitable treatment, or indirectly by creating a stressful and unhealthy environment. It is critical that physicians are aware of t...


Committee Opinion Number 665, June 2016

ABSTRACT: Considerable uncertainty exists about what constitutes appropriate levels of protection for adolescents as research participants and about the need for parental permission. The ethical principles that govern research include respect for individuals, beneficence, and justice, as articulated in the Belmont Report. Researchers should be familiar with and adhere to current federal regulations 45 C.F.R. § 46, and federal and state laws that affect research with minors. Investigators should understand the importance of caregiver permission—and ethically appropriate situations in which to ...


Committee Opinion Number 664, June 2016

(Replaces Committee Opinion Number 321, November 2005)

ABSTRACT: One of the most challenging scenarios in obstetric care occurs when a pregnant patient refuses recommended medical treatment that aims to support her well-being, her fetus’s well-being, or both. In such circumstances, the obstetrician–gynecologist’s ethical obligation to safeguard the pregnant woman’s autonomy may conflict with the ethical desire to optimize the health of the fetus. Forced compliance—the alternative to respecting a patient’s refusal of treatment—raises profoundly important issues about patient rights, respect for autonomy, violations of bodily integrity, power diffe...


Committee Opinion Number 660, March 2016

(Replaces Committee Opinion No. 397, February 2008)

ABSTRACT: Gestational surrogacy is an increasingly common form of family building that can allow individuals or a couple to become parents despite circumstances in which carrying a pregnancy is biologically impossible or medically contraindicated. The practice of gestational surrogacy involves a woman known as a gestational carrier who agrees to bear a genetically unrelated child with the help of assisted reproductive technologies for an individual or couple who intend(s) to be the legal and rearing parent(s), referred to as the intended parent(s). Obstetrician–gynecologists may become involv...


Committee Opinion Number 646, November 2015

(Replaces Committee Opinion No. 307, December 2004
and Committee Opinion No. 377, September 2007)

ABSTRACT: Inclusion of women in research studies is necessary for valid inferences about health and disease in women. The generalization of results from trials conducted in men may yield erroneous conclusions that fail to account for the biologic differences between men and women. Although significant changes in research design and practice have led to an increase in the proportion of women included in research trials, knowledge gaps remain because of a continued lack of inclusion of women, especially those who are pregnant, in premarketing research trials. This document provides a historical...


Committee Opinion Number 633, June 2015

(Replaces Committee Opinion Number 422, December 2008)

ABSTRACT: Alcohol abuse and other substance use disorders are major, often underdiagnosed health problems for women, regardless of age, race, ethnicity, and socioeconomic status, and have resulting high costs for individuals and society. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines substance use disorder as a pathologic pattern of behaviors related to the use of any of 10 separate classes of substances, including alcohol and licit and illicit substances. In order to optimize care of patients with substance use disorder, obstetrician–gynecologists are encou...


Statement of Policy 091, May 2015

Advocacy on behalf of women’s health is central to our mission. The United States Congress and Statehouses are increasingly affecting the practice of medicine, our specialty’s ability to care for our patients, and the future of women’s health. The American Congress of Obstetricians and Gynecologists supports member involvement in legislative and political advocacy to help ensure that lawmakers and government entities make informed decisions on issues related to women’s health.


Committee Opinion Number 624, February 2015

Reaffirmed 2017

ABSTRACT: Cytology-based cervical cancer screening programs require a number of elements to be successful. Certain low-resource settings, like the U.S. Affiliated Pacific Islands, lack these elements. Implementing alternative cervical cancer screening strategies in low-resource settings can provide consistent, accessible screening opportunities.


14.
January 2015

Committee Opinion Number 617, January 2015

(Replaces Committee Opinion Number 403, April 2008)

ABSTRACT: Obstetrician–gynecologists care for women throughout their lifespans and are in an ideal position to have ongoing discussions with healthy patients about their values and wishes regarding future care and to encourage them to complete an advance directive for health care. In addition, situations may arise in which obstetrician–gynecologists need to participate in end-of-life care. When end-of-life decisions need to be made while a woman is pregnant, the level of ethical complexity often is increased. The purpose of this Committee Opinion is to discuss ethical issues related to end-of...


15.
November 2014

Statement of Policy (Revised and approved November 2014), November 2014

The following statement is the American College of Obstetricians and Gynecologists’ (ACOG) general policy related to abortion. The College’s clinical guidelines related to abortion and additional information are contained in the relevant Practice Bulletins, Committee Opinions, and other College documents.


The health and economic benefits of paid parental leave are well documented. The American College of Obstetricians and Gynecologists (ACOG) endorses paid parental leave as essential. Paid parental leave includes maintenance of full benefits and 100% of pay for at least six weeks. Those who choose to have children should not face discrimination, and discrimination on the basis of pregnancy is explicitly prohibited. (1, 2) Workers who choose to have children make an equal commitment to the workplace and training environment as those who do not. Workers eligible for paid parental leave include ...


(Reaffirmed July 2014)

The American College of Obstetricians and Gynecologists (the College) and the American College of Nurse-Midwives (ACNM) affirm our shared goal of safe women's health care in the United States through the promotion of evidence-based models provided by obstetrician–gynecologists (ob-gyns), certified nurse-midwives (CNMs), and certified midwives (CMs). The College and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among providers. Ob-gyns and CNMs/CMs are experts in their respective fields of practice and are educated...


Statement of Policy (Amended and Reaffirmed July 2014), July 2014

The American College of Obstetricians and Gynecologists (the College) is the representative organization of physicians who are qualified specialists in providing health services to women. The College is committed to facilitating access to women’s health care that is both safe and high quality. One method of attaining this goal is to assure that providers of care meet educational and professional standards of a certification process. The College recognizes the educational and professional standards currently used by the American Midwifery Certification Board (AMCB) to evaluate and certify midw...


Statement of Policy (Reaffirmed July 2014), July 2014

The problem of perinatal transmission of HIV infection was first appreciated in 1982. In 1991, the Institute of Medicine (IOM) recommended a policy of routine counseling and offering testing (with specific informed consent) for HIV infection to all pregnant women. Since 1991, there have been major advances in the treatment of HIV infection, including demonstration in 1994 of the efficacy of zidovudine to reduce perinatal transmission. The U.S. Public Health Service subsequently issued guidelines for use of zidovudine to reduce perinatal transmission and for counseling and voluntary testing fo...


(Reaffirmed July 2014)

Access to maternity care is an important public health concern in the United States. Providing comprehensive perinatal services to a diverse population requires a cooperative relationship among a variety of health professionals, including social workers, health educators, nurses and physicians. Prenatal care, labor and delivery, and postpartum care have historically been provided by midwives, family physicians and obstetricians. All three remain the major caregivers today. A cooperative and collaborative relationship among obstetricians, family physicians and nurse midwives is essential for p...


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