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Committee Opinion Number 693, April 2017

ABSTRACT: Given the increasing availability and complexity of genetic testing, it is imperative that the practicing obstetrician–gynecologist or other health care provider has a firm comprehension of the benefits, limitations, and risks of offering a specific genetic test, as well as the importance of appropriate pretest and posttest counseling. The purpose of this Committee Opinion is to provide an outline of how obstetrician–gynecologists and other health care providers can best incorporate these tests into their current practices and provide appropriate pretest and posttest counseling to p...


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 ...


Committee Opinion Number 690, March 2017

ABSTRACT: Carrier screening, whether targeted or expanded, allows individuals to consider their range of reproductive options. Ultimately, the goal of genetic screening is to provide individuals with meaningful information that they can use to guide pregnancy planning based on their personal values. Ethnic-specific, panethnic, and expanded carrier screening are acceptable strategies for prepregnancy and prenatal carrier screening. Because all of these are acceptable strategies, each obstetrician–gynecologist or other health care provider or practice should establish a standard approach that i...


Committee Opinion Number 688, March 2017

ABSTRACT: The American College of Obstetricians and Gynecologists considers first-trimester ultrasonography to be the most accurate method to establish or confirm gestational age. Pregnancies without an ultrasonographic examination confirming or revising the estimated due date before 22 0/7 weeks of gestation should be considered suboptimally dated. This document provides guidance for managing pregnancies in which the best clinical estimate of gestational age is suboptimal. There is no role for elective delivery in a woman with a suboptimally dated pregnancy. Although guidelines for indicated...


Committee Opinion Number 682, December 2016

(Replaces Committee Opinion Number 581, December 2013)

ABSTRACT: Genetic technology has advanced dramatically in the past few decades, and its applications and use in caring for and counseling pregnant women has been transformational in the realm of prenatal diagnosis. Two of the newer genetic technologies in the prenatal setting are chromosomal microarray and whole-exome sequencing. Chromosomal microarray analysis is a method of measuring gains and losses of DNA throughout the human genome. It can identify chromosomal aneuploidy and other large changes in the structure of chromosomes as well as submicroscopic abnormalities that are too small to ...


Committee Opinion Number 678, November 2016

ABSTRACT: Current sexuality education programs vary widely in the accuracy of content, emphasis, and effectiveness. Data have shown that not all programs are equally effective for all ages, races and ethnicities, socioeconomic groups, and geographic areas. Studies have demonstrated that comprehensive sexuality education programs reduce the rates of sexual activity, sexual risk behaviors (eg, number of partners and unprotected intercourse), sexually transmitted infections, and adolescent pregnancy. One key component of an effective program is encouraging community-centered efforts. In addition...


Committee Opinion Number 645, November 2015

ABSTRACT: Gonorrhea is the second most commonly reported bacterial sexually transmitted disease in the United States, with an estimated 820,000 new Neisseria gonorrhoeae infections occurring each year. Antimicrobial resistance limits treatment success, heightens the risk of complications, and may facilitate the transmission of sexually transmitted infections. Neisseria gonorrhoeae has developed resistance to the sulfonamides, the tetracyclines, and penicillin. Dual therapy with ceftriaxone and azithromycin remains the only recommended first-line regimen for the treatment of gonorrhea in the U...


8.
October 2015

Committee Opinion Number 644, October 2015

(Replaces Committee Opinion Number 333, May 2006) (Reaffirmed 2017)

ABSTRACT: The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed. The Apgar score alone cannot be considered to be evidence of or a consequence of asphyxia, does not predict individual neonatal mortality or neurologic outcome, and should not be used for that purpose. An Apgar score assigned during a resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. The American Academy of Pediatrics and the American College of Obstetricians and Gynecolog...


Committee Opinion Number 643, October 2015

Reaffirmed 2017

ABSTRACT: Advances in the understanding of genetic conditions, reproductive technologies, and improved medical and surgical care have enabled an increasing number of women with genetic conditions to achieve a normal pregnancy outcome. However, management of certain genetic conditions during pregnancy is complex and may require a multidisciplinary approach from preconception through the postpartum period. Patients with certain genetic conditions, or those at risk of having a particular genetic condition, should have a preconception evaluation with their obstetrician–gynecologists, genetics spe...


Committee Opinion Number 640, September 2015

(This Committee Opinion Replaces Committee Opinion Number 545) (Reaffirmed 2017)

ABSTRACT: Noninvasive prenatal screening that uses cell-free DNA from the plasma of pregnant women offers tremendous potential as a screening method for fetal aneuploidy. A number of laboratories have validated different techniques for the use of cell-free DNA as a screening test for fetal aneuploidy. All tests have a high sensitivity and specificity for trisomy 18 and trisomy 21, regardless of which molecular technique is used. Women whose results are not reported, indeterminate, or uninterpretable (a “no call” test result) from cell-free DNA screening should receive further genetic counseli...


Committee Opinion Number 638, September 2015

(Reaffirmed 2017)

ABSTRACT: Hypertensive disorders with adverse sequelae (including preterm birth, maternal morbidity and mortality, and long-term risk of maternal cardiovascular disease) complicate 5–10% of pregnancies. Early identification of pregnant women at risk of developing early-onset preeclampsia would theoretically allow referral for more intensive surveillance or application of preventive therapies to reduce the risk of severe disease. In practice, however, the effectiveness of such triage would be hindered by the low positive predictive value for early-onset preeclampsia reported in the literature....


Committee Opinion Number 634, June 2015

Reaffirmed 2017

ABSTRACT: A hereditary cancer syndrome is a genetic predisposition to certain types of cancer, often with onset at an early age, caused by inherited mutations in one or more genes. Cases of cancer commonly encountered by obstetrician–gynecologists or other obstetric–gynecologic providers—such as breast cancer, ovarian cancer, and endometrial cancer—are features of specific hereditary cancer syndromes. The most common hereditary cancer syndromes related to gynecologic cancer include hereditary breast and ovarian cancer syndrome, Lynch syndrome, Li–Fraumeni syndrome, Cowden syndrome...


Committee Opinion Number 630, May 2015

(Replaces Committee Opinion Number 453, February 2010, Reaffirmed 2016)

ABSTRACT: Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects on women, infants, and families. Several screening instruments have been validated for use during pregnancy and the postpartum period. Although definitive ev...


Committee Opinion Number 625, March 2015

(Reaffirmed 2017)

ABSTRACT: Women with dense breasts have a modestly increased risk of breast cancer and experience reduced sensitivity of mammography to detect breast cancer. However, evidence is lacking to advocate for additional testing until there are clinically validated data that indicate improved screening outcomes. Currently, screening mammography remains the most useful tool for breast cancer detection and consistently has demonstrated a reduction in breast cancer mortality. The American College of Obstetricians and Gynecologists does not recommend routine use of alternative or adjunctive tests to scr...


Committee Opinion Number 616, January 2015

(Replaces Committee Opinion Number 481, March 2011, Reaffirmed 2016)

ABSTRACT: Newborn screening is a mandatory state-based public health program that provides all newborns in the United States with presymptomatic testing and necessary follow-up health care for a variety of medical conditions. The goal of this essential public health program is to decrease morbidity and mortality by screening for disorders in which early intervention will improve neonatal and long-term health outcomes. The results of surveys and focus groups of expectant parents demonstrate that women and their families would like to receive information about newborn screening during their pre...


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 603, June 2014

(Reaffirmed 2016)

ABSTRACT: Stress urinary incontinence (SUI) is a condition of involuntary loss of urine on effort, physical exertion, sneezing, or coughing that is often bothersome to the patient and frequently affects quality of life. When women are evaluated for SUI, counseling about treatment should begin with conservative options. The minimum evaluation before primary midurethral sling surgery in women with symptoms of SUI includes the following six steps: 1) history, 2) urinalysis, 3) physical examination, 4) demonstration of stress incontinence, 5) assessment of urethral mobility, and 6) measurement of...


18.
December 2012

Committee Opinion Number 546, December 2012

(Reaffirmed 2016. Replaces No. 461, August 2010)

ABSTRACT: An accurate and effective tracking or reminder system is useful for the modern practice of obstetrics and gynecology. Practices should not rely solely on the patient to complete all ordered studies and to follow up on health care provider recommendations. Health care providers should encourage their patients to complete studies believed essential for patient care within an acceptable time frame. Each office should establish a simple, reliable tracking and reminder system to facilitate communication, improve patient safety and quality of care, and minimize missed or delayed diagnoses.


Committee Opinion Number 537, October 2012

(Reaffirmed 2016)

ABSTRACT: The reprocessing and reuse of single-use instruments has become increasingly common. Although there are limited data on reprocessed single-use devices, existing studies have found a significant rate of physical defects, performance issues, or improper decontamination. There are currently no data in the medical literature of studies evaluating the cost-effectiveness of reprocessed single-use devices in gynecologic surgery. The use of a reprocessed single-use device provides no direct benefit to an individual patient or her physician. It is the operating surgeon’s ethical responsibili...


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...


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