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Committee Opinion Number 696, April 2017

(Replaces Committee Opinion Number 474, February 2011)

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. 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 qualified to discuss aspects of maternal physiology and anatomy that may affect intraoperative maternal–fetal well-being. Ultimately, each case warrants a t...


2.
January 2015

Committee Opinion Number 618, January 2015

(Reaffirmed 2017)

ABSTRACT: The main goal of ovarian reserve testing is to identify those individuals who are at risk of decreased or diminished ovarian reserve, commonly known as DOR. Although ovarian reserve testing cannot predict the end of one’s reproductive years, results outside the range expected for a patient’s age can encourage the individual to pursue more aggressive treatment options to achieve pregnancy. Ovarian reserve testing should be performed for women older than 35 years who have not conceived after 6 months of attempting pregnancy and women at higher risk of diminished ovarian reserve. When ...


Committee Opinion Number 610, October 2014

(Reaffirmed 2016)

ABSTRACT: Surgery can present a management dilemma for gynecologists whose patients receive chronic antithrombotic therapy because the risk of hemorrhagic complications must be balanced against the risk of thromboembolic complications. Interruption of antithrombotic therapy to reduce perioperative bleeding poses a significant risk of recurrent thromboembolic events. Patients who receive chronic antithrombotic therapy should be seen at least 7 days before a planned procedure, and each woman should be included in decision making regarding risks and benefits specific to her situation. The schedu...


Committee Opinion Number 606, August 2014

(Reaffirmed 2016)

ABSTRACT: Adolescents undergoing cancer treatment are at high risk of heavy menstrual bleeding, and gynecologists may be consulted either before the initiation of cancer treatment to request strategies for menstrual suppression or during an episode of severe heavy bleeding to stop the bleeding emergently. Therapy in both situations should be tailored to the patient, her cancer diagnosis and treatment plan, and her desires for contraception and fertility. Options for menstrual suppression include combined hormonal contraceptives, progestin-only therapy, and gonadotropin-releasing hormone agoni...


Committee Opinion Number 605, July 2014

(Reaffirmed 2016)

ABSTRACT: Primary ovarian insufficiency is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years. There is no consensus on criteria to identify primary ovarian insufficiency in adolescents, and delay in diagnosis is common. Health care providers who make this clinical diagnosis should be mindful of the sensitive nature of this medical condition. Patients and their families should be counseled on the effect of the patient’s condition on future fertility, on the risk of comorbidities associated with primary ovarian insufficiency, and on the condition’s p...


Committee Opinion Number 557, April 2013

(Reaffirmed 2017)

ABSTRACT: Initial evaluation of the patient with acute abnormal uterine bleeding should include a prompt assessment for signs of hypovolemia and potential hemodynamic instability. After initial assessment and stabilization, the etiologies of acute abnormal uterine bleeding should be classified using the PALM–COEIN system. Medical management should be the initial treatment for most patients, if clinically appropriate. Options include intravenous conjugated equine estrogen, multi-dose regimens of combined oral contraceptives or oral progestins, and tranexamic acid. Decisions should be based on ...


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