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Ultrasound in Pregnancy


OB  Practice Bulletin | December 2016
Source: ACOG

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Obstetric ultrasonography is an important and common part of obstetric care in the United States. The purpose of this document is to present information and evidence regarding the methodology of, indications for, benefits of, and risks associated with obstetric ultrasonography in specific clinical situations. Portions of this Practice Bulletin were developed from collaborative documents with the American College of Radiology and the American Institute of Ultrasound in Medicine.
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Early Pregnancy Loss


OB  Practice Bulletin | November 2018
Source: ACOG

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Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management. The purpose of this Practice Bulletin is to review diagnostic approaches and describe options for the management of early pregnancy loss.
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BRCA1 and BRCA2 Mutations


GYN  FAQs
Source: ACOG

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BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.
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Management of Symptomatic Uterine Leiomyomas


OB  Practice Bulletin | June 2021
Source: ACOG

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Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy, which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication.
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Gestational Hypertension and Preeclampsia


OB  Practice Bulletin | June 2020
Source: ACOG

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Uterine leiomyomas (fibroids) are the most common solid and symptomatic neoplasm in women. They are the leading indication for hysterectomy, which is a definitive and effective surgical treatment for leiomyoma. However, many patients benefit from and seek out management options other than hysterectomy because they desire future childbearing or wish to retain their uterus. The purpose of this Practice Bulletin is to provide updated evidence-based recommendations for the medical, procedural, and surgical management of symptomatic leiomyomas. Discussion of the use of morcellation in the surgical management of leiomyomas is beyond the scope of this document and is addressed in a separate American College of Obstetricians and Gynecologists (ACOG) publication.
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Prelabor Rupture of Membranes


OB  Practice Bulletin | March 2020
Source: ACOG

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Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality. Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2–3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies.
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Indications for Outpatient Antenatal Fetal Surveillance


OB  Practice Bulletin | June 2021
Source: ACOG

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The purpose of this Committee Opinion is to offer guidance about indications for and timing and frequency of antenatal fetal surveillance in the outpatient setting. Antenatal fetal surveillance is performed to reduce the risk of stillbirth. However, because the pathway that results in increased risk of stillbirth for a given condition may not be known and antenatal fetal surveillance has not been shown to improve perinatal outcomes for all conditions associated with stillbirth, it is challenging to create a prescriptive list of all indications for which antenatal fetal surveillance should be considered.
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Carrier Screening in the Age of Genomic Medicine


OB  Committee Opinion | March 2017
Source: ACOG

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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.
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Hereditary Cancer Syndromes and Risk Assessment


GYN  Committee Opinion | December 2019
Source: ACOG

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A hereditary cancer syndrome is a genetic predisposition to certain types of cancer, often with onset at an early age, caused by inherited pathogenic variants in one or more genes. Most hereditary cancer syndromes exhibit autosomal dominant inheritance. The most common hereditary cancer syndromes related to women’s cancer include hereditary breast and ovarian cancer syndrome, Lynch syndrome, Li–Fraumeni syndrome, Cowden syndrome, Peutz–Jeghers syndrome, and hereditary diffuse gastric cancer.
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Management of Stillbirth


OB  Obstetric Care Consensus | March 2020
Source: ACOG

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Stillbirth is one of the most common adverse pregnancy outcomes, occurring in 1 in 160 deliveries in the United States. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable (such as smoking), many are not.
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Newborn Screening and the Role of the Obstetrician–Gynecologist


OB  Committee Opinion | May 2019
Source: ACOG

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Newborn screening is the largest genetic screening program in the United States, with approximately 4 million infants screened annually. Newborn screening is a mandatory state-based public health program that provides all newborns in the United States with testing and necessary follow-up health care for a variety of medical conditions. The goal of this 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.
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Interpregnancy Care


OB  Obstetric Care Consensus | January 2019
Source: ACOG

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Interpregnancy care aims to maximize a woman’s level of wellness not just in between pregnancies and during subsequent pregnancies, but also along her life course. Because the interpregnancy period is a continuum for overall health and wellness, all women of reproductive age who have been pregnant regardless of the outcome of their pregnancies (ie, miscarriage, abortion, preterm, full-term delivery), should receive interpregnancy care as a continuum from postpartum care.
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Infertility Workup for the Women’s Health Specialist


GYN  Committee Opinion | June 2019
Source: ACOG

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Infertility, defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples. An infertility evaluation may be offered to any patient who by definition has infertility or is at high risk of infertility.
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Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women


GYN  Committee Opinion | April 2013
Source: ACOG

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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.
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Breastfeeding Challenges


OB  Committee Opinion | February 2021
Source: ACOG

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Breastfeeding is associated with a decrease in a woman’s risk of breast cancer, ovarian cancer, diabetes mellitus, and hypertensive heart disease. Breastfeeding initiation rates in the United States are increasing, and many women are aware of the maternal and infant health benefits of breastfeeding. However, problems may arise that can keep women from achieving their breastfeeding goals, and only 25% of women in the United States are breastfeeding exclusively at 6 months. Many women experience early and undesired weaning because of persistent pain or nipple injury .
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Ethical Issues in Genetic Testing


OB  Committee Opinion | June 2008
Source: ACOG

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Genetic testing is poised to play an increasing role in the practice of obstetrics and gynecology. To assure patients of the highest quality of care, physicians should become familiar with the currently available array of genetic tests and the tests’ limitations. Clinicians should be able to identify patients within their practices who are candidates for genetic testing. Candidates will include patients who are pregnant or considering pregnancy and are at risk for giving birth to affected children as well as gynecology patients who, for example, may have or be predisposed to certain types of cancer. The purpose of this Committee Opinion is to review some of the ethical issues related to genetic testing and provide guidelines for the appropriate use of genetic tests by obstetrician–gynecologists.
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Compounded Bioidentical Menopausal Hormone Therapy


GYN  Committee Opinion | August 2012
Source: ACOG

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Although improvement in long-term health is no longer an indication for menopausal hormone therapy, evidence supporting fewer adverse events in younger women, combined with its high overall effectiveness, has reinforced its usefulness for short-term treatment of menopausal symptoms. Menopausal therapy has been provided not only by commercially available products but also by compounding, or creation of an individualized preparation in response to a health care provider’s prescription to create a medication tailored to the specialized needs of an individual patient.
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Labor Induction or Augmentation and Autism


OB  Committee Opinion | May 2014
Source: ACOG

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Functional oxytocin deficiency and a faulty oxytocin signaling pathway have been observed in conjunction with autism spectrum disorder (ASD). Because exogenous synthetic oxytocin commonly is administered for labor induction and augmentation, some have hypothesized that synthetic oxytocin used for these purposes may alter fetal oxytocin receptors and predispose exposed offspring to ASD. However, current evidence does not identify a causal relationship between labor induction or augmentation in general, or oxytocin labor induction specifically, and autism or ASD.
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Shoulder Dystocia


OB  Practice Bulletin | May 2017
Source: ACOG

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Shoulder dystocia is an unpredictable and unpreventable obstetric emergency that places the pregnant woman and fetus at risk of injury. Studies have shown that prepregnancy, antepartum, and intrapartum risk factors have extremely poor predictive value for shoulder dystocia. Several techniques to facilitate delivery exist, and there is evidence that a systematic approach and simulation training can improve outcomes and documentation. The purpose of this document is to provide clinicians with evidence-based information regarding management of pregnancies and deliveries at risk of or complicated by shoulder dystocia.
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Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign


GYN  Committee Opinion | December 2015
Source: ACOG

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Despite variations worldwide and within the U.S. population, median age at menarche has remained relatively stable—between 12 years and 13 years—across well-nourished populations in developed countries. Environmental factors, including socioeconomic conditions, nutrition, and access to preventive health care, may influence the timing and progression of puberty. A number of medical conditions can cause abnormal uterine bleeding, characterized by unpredictable timing and variable amount of flow.
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Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management


OB  Clinical Consensus | September 2021
Source: ACOG

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Pain in the postpartum period is common and considered by many individuals to be both problematic and persistent. Pain can interfere with individuals’ ability to care for themselves and their infants, and untreated pain is associated with risk of greater opioid use, postpartum depression, and development of persistent pain. Clinicians should therefore be skilled in individualized management of postpartum pain.
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The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology


GYN  Committee Opinion | March 2020
Source: ACOG

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This Committee Opinion provides guidance on the current uses of hysteroscopy in the office and the operating room for the diagnosis and treatment of intrauterine pathology and the potential associated complications. General considerations for the use of diagnostic and operative hysteroscopy include managing distending media, timing for optimal visualization, and cervical preparations. In premenopausal women with regular menstrual cycles, the optimal timing for diagnostic hysteroscopy is during the follicular phase of the menstrual cycle after menstruation.
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Placenta Accreta Spectrum


OB  Obstetric Care Consensus | December 2018
Source: ACOG

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Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. The most favored hypothesis regarding the etiology of placenta accreta spectrum is that a defect of the endometrial–myometrial interface leads to a failure of normal decidualization in the area of a uterine scar, which allows abnormally deep placental anchoring villi and trophoblast infiltration.
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Severe Maternal Morbidity: Screening and Review


OB  Obstetric Care Consensus | September 2016
Source: ACOG

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This document builds upon recommendations from peer organizations and outlines a process for identifying maternal cases that should be reviewed. Severe maternal morbidity is associated with a high rate of preventability, similar to that of maternal mortality. It also can be considered a near miss for maternal mortality because without identification and treatment, in some cases, these conditions would lead to maternal death.
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Effective Patient-Physician Communication


OB / GYN  Committee Opinion | February 2014
Source: ACOG

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Physicians’ ability to effectively and compassionately communicate information is key to a successful patient–physician relationship. The current health care environment demands increasing clinical productivity and affords less time with each patient, which can impede effective patient–physician communication. The use of patient-centered interviewing, caring communication skills, and shared decision making improves patient–physician communication.
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Quantitative Blood Loss in Obstetric Hemorrhage


OB  Committee Opinion | December 2019
Source: ACOG

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Postpartum hemorrhage causes approximately 11% of maternal deaths in the United States and is the leading cause of death that occurs on the day of birth. Importantly, 54–93% of maternal deaths due to obstetric hemorrhage may be preventable. Studies that have evaluated factors associated with identification and treatment of postpartum hemorrhage have found that imprecise health care provider estimation of actual blood loss during birth and the immediate postpartum period is a leading cause of delayed response to hemorrhage.
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Antenatal Corticosteroid Therapy for Fetal Maturation


OB  Committee Opinion | August 2017
Source: ACOG

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Corticosteroid administration before anticipated preterm birth is one of the most important antenatal therapies available to improve newborn outcomes. A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, including for those with ruptured membranes and multiple gestations.
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Persistent Vulvar Pain


GYN  Committee Opinion | September 2016
Source: ACOG

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Persistent vulvar pain is a complex disorder that frequently is frustrating to the patient and the clinician. It can be difficult to treat and rapid resolution is unusual, even with appropriate therapy. Vulvar pain can be caused by a specific disorder or it can be idiopathic. Idiopathic vulvar pain is classified as vulvodynia. Although optimal treatment remains unclear, consider an individualized, multidisciplinary approach to address all physical and emotional aspects possibly attributable to vulvodynia.
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Low-Dose Aspirin Use During Pregnancy


OB  Committee Opinion | July 2018
Source: ACOG

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Low-dose aspirin has been used during pregnancy, most commonly to prevent or delay the onset of preeclampsia. The American College of Obstetricians and Gynecologists issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin beginning in the late first trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks of gestation, or for women with more than one prior pregnancy complicated by preeclampsia.
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