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Committee Opinion Number 561, April 2013

(Reaffirmed 2017)

ABSTRACT: For certain medical conditions, available data and expert opinion support optimal timing of delivery in the late-preterm or early-term period for improved neonatal and infant outcomes. However, for nonmedically indicated early-term deliveries such an improvement has not been demonstrated. Morbidity and mortality rates are greater among neonates and infants delivered during the early-term period compared with those delivered between 39 weeks and 40 weeks of gestation. Nevertheless, the rate of nonmedically indicated early-term deliveries continues to increase in the United States. Im...


Committee Opinion Number 560, April 2013

(Reaffirmed 2017)

ABSTRACT: The neonatal risks of late preterm (34 0/7–36 6/7 weeks of gestation) and early-term (37 0/7–38 6/7 weeks of gestation) births are well established. 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 of further continuation of pregnancy. Decisions regarding timing of delivery must be individualized. Amniocentesis for the determination of fetal lung maturity ...


Committee Opinion Number 559, April 2013

(Reaffirmed 2017)

ABSTRACT: Cesarean delivery on maternal request is defined as a primary prelabor cesarean delivery on maternal request in the absence of any maternal or fetal indications. Potential risks of cesarean delivery on maternal request include a longer maternal hospital stay, an increased risk of respiratory problems for the infant, and greater complications in subsequent pregnancies, including uterine rupture, placental implantation problems, and the need for hysterectomy. Potential short-term benefits of planned cesarean delivery compared with a planned vaginal delivery (including women who give b...


Committee Opinion Number 555, March 2013

(Reaffirmed 2016)

ABSTRACT: Numerous occurrences in the past decade have brought the issue of disaster preparedness, and specifically hospital preparedness, to the national forefront. Much of the work in this area has focused on large hospital system preparedness for various disaster scenarios. Many unique features of the obstetric population warrant additional consideration in order to optimize the care received by expectant mothers and their fetuses or newborns in the face of future natural or biologic disasters.


45.
February 2013

Committee Opinion Number 553, February 2013

(Reaffirmed 2016. Replaces Committee Opinion Number 369, June 2007)

ABSTRACT: Fertility treatments have contributed significantly to the increase in multifetal pregnancies. The first approach to the problem of multifetal pregnancies should be prevention, and strategies to limit multifetal pregnancies, especially high-order multifetal pregnancies, should be practiced by all physicians who treat women for infertility. Incorporating the ethical frameworks presented in this Committee Opinion will help physicians counsel and guide patients when making decisions regarding multifetal pregnancy reduction. In cases of high-order multifetal pregnancies, counseling shou...


Committee Opinion Number 552, January 2013

(Reaffirmed 2016)

ABSTRACT: Many U.S. women are uninsured and face avoidable adverse obstetric and gynecologic health outcomes. The Affordable Care Act requires an expansion of Medicaid that would increase the percentage of U.S. women with health insurance, with the anticipated benefit of improved health. The 2012 Supreme Court decision allows states to opt out of Medicaid expansion. The American College of Obstetricians and Gynecologists supports appropriate reimbursement to health care providers and the expansion of Medicaid as key strategies to improve women’s health.


Committee Opinion Number 550, January 2013

(Reaffirmed 2016)

ABSTRACT: Myelomeningocele, the most severe form of spina bifida, occurs in approximately 1 in 1,500 births in the United States. Fetuses in whom myelomeningocele is diagnosed typically are delivered at term and are treated in the early neonatal period. A recent randomized controlled trial found that fetal surgery for myelomeningocele improved a number of important outcomes, but also was associated with maternal and fetal risks. Maternal–fetal surgery is a major procedure for the woman and her fetus, and it has significant implications and complications that occur acutely, postoperatively, fo...


48.
January 2013

Committee Opinion Number 548, January 2013

(Reaffirmed 2016)

ABSTRACT: The updated guidelines by the Institute of Medicine regarding gestational weight gain provide clinicians with a basis for practice. Health care providers who care for pregnant women should determine a woman’s body mass index at the initial prenatal visit and counsel her regarding the benefits of appropriate weight gain, nutrition and exercise, and, especially, the need to limit excessive weight gain to achieve best pregnancy outcomes. Individualized care and clinical judgment are necessary in the management of the overweight or obese woman who is gaining (or wishes to gain) less wei...


Committee Opinion Number 535, August 2012

ABSTRACT: Increasing numbers of women and adolescent females are incarcerated each year in the United States and they represent an increasing proportion of inmates in the U.S. correctional system. Incarcerated women and adolescent females often come from disadvantaged environments and have high rates of chronic illness, substance abuse, and undetected health problems. Most of these females are of reproductive age and are at high risk of unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). Understanding the needs of incarcerated women and adol...


Committee Opinion Number 533, August 2012

(Reaffirmed 2016)

Abstract: Prenatal lead exposure has known adverse effects on maternal health and infant outcomes across a wide range of maternal blood lead levels. Adverse effects of lead exposure are being identified at lower levels of exposure than previously recognized in both children and adults. In 2010, the Centers for Disease Control and Prevention issued the first guidelines regarding the screening and management of pregnant and lactating women who have been exposed to lead.


51.
August 2012

Committee Opinion Number 531, August 2012

(Reaffirmed 2016. Replaces No. 331, April 2006 and No. 400, March 2008)

ABSTRACT: Despite significant national attention, medical errors continue to pervade the U.S. health care system. Medication-related errors consistently rank at the top of all medical errors, which account for thousands of preventable deaths annually in the United States. There are a variety of methods—ranging from broad-based error reduction strategies to the adoption of sophisticated health information technologies—that can assist obstetrician–gynecologists in minimizing the risk of medication errors. Practicing obstetrician–gynecologists should be familiar with these various approaches tha...


Committee Opinion Number 530, July 2012

(Reaffirmed 2016)

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 ...


53.
July 2012

Committee Opinion Number 529, July 2012

(Reaffirmed 2017)

ABSTRACT: Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and ...


Committee Opinion Number 527, June 2012

(Reaffirmed 2016)

ABSTRACT: Advances in genetic technologies have led to the identification of hundreds of single nucleotide polymorphisms that are associated with a variety of complex diseases, including cancer, diabetes, cardiovascular disease, and Alzheimer disease. Although personalized genomic tests that provide information regarding the risk of development of multiple diseases may be important tools in the near future, their use is not recommended outside of a clinical trial until these tests are validated as clinically useful in appropriately designed prospective studies. Testing for single-gene disorde...


Committee Opinion Number 524, May 2012

(Reaffirmed 2016)

ABSTRACT: Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise. Du...


56.
February 2012

Committee Opinion Number 518, February 2012

ABSTRACT: Intimate partner violence (IPV) is a significant yet preventable public health problem that affects millions of women regardless of age, economic status, race, religion, ethnicity, sexual orientation, or educational background. Individuals who are subjected to IPV may have lifelong consequences, including emotional trauma, lasting physical impairment, chronic health problems, and even death. Although women of all ages may experience IPV, it is most prevalent among women of reproductive age and contributes to gynecologic disorders, pregnancy complications, unintended pregnancy, and s...


Committee Opinion Number 511, November 2011

Reaffirmed 2016

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.


Committee Opinion Number 501, August 2011

(Reaffirmed 2014)

ABSTRACT: The past two decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and t...


Committee Opinion Number 498, August 2011

(Reaffirmed 2015)

ABSTRACT: Long-term effects of childhood sexual abuse are varied, complex, and often devastating. Many obstetrician-gynecologists knowingly or unknowingly provide care to abuse survivors and should screen all women for a history of such abuse. Depression, anxiety, and anger are the most commonly reported emotional responses to childhood sexual abuse. Gynecologic problems, including chronic pelvic pain, dyspareunia, vaginismus, nonspecific vaginitis, and gastrointestinal disorders are common diagnoses among survivors. Survivors may be less likely to have regular Pap tests and may seek little o...


Committee Opinion Number 496, August 2011

(Reaffirmed 2013)

ABSTRACT: Compared with men, at-risk alcohol use by women has a disproportionate effect on their health and lives, including reproductive function and pregnancy outcomes. Obstetrician–gynecologists have a key role in screening and providing brief intervention, patient education, and treatment referral for their patients who drink alcohol at risk levels. For women who are not physically addicted to alcohol, tools such as brief intervention and motivational interviewing can be used effectively by the clinician and incorporated into an office visit. For pregnant women and those at risk of pregna...


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