Washington, DC—Today, the American College of Obstetricians and Gynecologists (ACOG) issued an updated version of its approach to preventive care, the "Well-Woman Visit" Committee Opinion, coinciding with the release of the ACOG-led Women’s Preventive Services Initiative’s (WPSI) new Well-Woman Chart.
The Well-Woman Chart is a comprehensive tool that summarizes preventive services recommendations for women from the WPSI, U.S. Preventive Services Task Force (USPSTF) and Bright Futures. It is organized by age-group and services are broken into the following categories: general health, infectious diseases and cancer.
The updated Committee Opinion includes WPSI as an important source for recommendations for well-woman care and reflects new guidance on components of the physical examination. Together, these resources provide ways for ob-gyns and other women’s health care providers to approach the numerous components of well-woman care, including how to prioritize them to ensure an incremental, timely and collaborative approach to preventive care.
“To better address the specific and unique needs of each woman more comprehensively, preventive services and corresponding recommendations have expanded and further emphasize the role of the ob-gyn,” said Christopher Zahn, M.D., ACOG’s vice president of Practice Activities. “These resources strive to support ob-gyns and other women’s health care providers as they navigate these changes by providing well-organized and comprehensive sources of women’s preventive care recommendations.”
The last decade has seen many changes to women’s preventive care recommendations that altered the focus of a well-woman visit for both patients and providers. These include a move away from the yearly Pap test, an increase in the popularity of long-acting reversible contraceptive methods and most recently, ACOG’s updated guidance regarding the performance of the pelvic exam.
While this means that women may not need cervical cancer screening or a pelvic examination at every preventive visit, it highlights an opportunity to approach additional important components of a well-woman visit, including the ability to address overall and long-term health considerations. By highlighting key health services for every life stage, the chart establishes an ongoing discussion between women and their ob-gyns about what their care should include now, next year and in the future.
“Increasingly, women look to their ob-gyn for both reproductive and primary health care, which creates an exciting opportunity for ob-gyns to build even deeper and longer lasting relationships with our patients,” said Zahn. “An ob-gyn may care for a patient as an adolescent, through her reproductive years, and as she experiences menopause and beyond. These resources are here to ensure that these ongoing updates to well-woman recommendations are manageable and positive for women’s health care providers and the women who are in their care.”
The services listed in the Well-Woman Chart should not be viewed as what is expected to be performed at every well-woman visit by every provider. Instead, the breadth of services listed reflects that each woman is unique, as are her healthcare needs. Decisions regarding when to initiate screening, how often to screen, and when to stop screening should be based on available evidence and include a shared decision-making process involving the woman and her health care provider.
The well-woman chart is available to ob-gyns and all health care providers on the WPSI website. It will be accompanied by clinical summary tables that provide additional detail about the preventive services listed. To help maximize the effectiveness and usefulness of the chart, ACOG has prepared a corresponding toolkit and FAQ for ob-gyns about how to incorporate it into practice.
Committee Opinion #755, "The Well-Woman Visit," appears in the October issue of Obstetrics & Gynecology.
Other titles appearing in Obstetrics & Gynecology this month:
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 the symptoms of influenza, adequately assess severity, and readily prescribe safe and effective antiviral therapy for pregnant women with suspected or confirmed influenza. Over-the-phone treatment for low-risk patients is preferred to help reduce the spread of disease among other pregnant patients in the office. Obstetrician– gynecologists and other obstetric care providers should treat pregnant women with suspected or confirmed influenza with antiviral medications presumptively based on clinical evaluation, regardless of vaccination status or laboratory test results. Pregnant women with suspected or confirmed influenza infection should receive antiviral treatment with oseltamivir or zanamivir based on the current resistance patterns. Treatment within 48 hours of the onset of symptoms is ideal but treatment should not be withheld if the ideal window is missed. Because of the high potential for morbidity and mortality for pregnant and postpartum patients, the Centers for Disease Control and Prevention advises that postexposure antiviral chemoprophylaxis can be considered for pregnant women and women who are up to 2 weeks postpartum (including after pregnancy loss) who have had close contact with infectious individuals.
The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician–gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician–gynecologist or other gynecologic care provider.
As reproductive health experts and advocates for women’s health who work in conjunction with other obstetric and pediatric health care providers, obstetrician–gynecologists are uniquely positioned to enable women to achieve their infant feeding goals. Maternity care policies and practices that support breastfeeding are improving nationally; however, more work is needed to ensure all women receive optimal breastfeeding support during prenatal care, during their maternity stay, and after the birth occurs. Enabling women to breastfeed is a public health priority because, on a population level, interruption of lactation is associated with adverse health outcomes for the woman and her child, including higher maternal risks of breast cancer, ovarian cancer, diabetes, hypertension, and heart disease, and greater infant risks of infectious disease, sudden infant death syndrome, and metabolic disease. Contraindications to breastfeeding are few. Most medications and vaccinations are safe for use during breastfeeding, with few exceptions. Breastfeeding confers medical, economic, societal, and environmental advantages; however, each woman is uniquely qualified to make an informed decision surrounding infant feeding. Obstetrician–gynecologists and other obstetric care providers should discuss the medical and nonmedical benefits of breastfeeding with women and families. Because lactation is an integral part of reproductive physiology, all obstetrician–gynecologists and other obstetric care providers should develop and maintain skills in anticipatory guidance, support for normal breastfeeding physiology, and management of common complications of lactation. Obstetrician–gynecologists and other obstetric care providers should support women and encourage policies that enable women to integrate breastfeeding into their daily lives and in the workplace. This Committee Opinion has been revised to include additional guidance for obstetrician–gynecologists and other obstetric care providers to better enable women in unique circumstances to achieve their breastfeeding goals.
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org