Category Archives: GUIDELINES

Safe Prevention of the Primary Cesarean Delivery

In response to concerns that cesarean delivery may be overused.

The American College of Obstetricians and Gynecologists (the College) and the Society for Maternal-Fetal Medicine has Published Guidelines

First stage of labor

  • Cervical dilation of 6 cm should be considered the threshold for the active phase of most women in labor. Thus, before 6 cm of dilation is achieved, standards of active phase progress should not be applied.
  • Cesarean delivery for active phase arrest in the first stage of labor should be reserved for women at or beyond 6 cm of dilation with ruptured membranes who fail to progress despite 4 hours of adequate uterine activity, or at least 6 hours of oxytocin administration with inadequate uterine activity and no cervical change.

Second stage of labor

Before diagnosing arrest of labor in the second stage, if the maternal and fetal conditions permit, allow for the following:

  • At least 2 hours of pushing in multiparous women
  • At least 3 hours of pushing in nulliparous women

Longer durations may be appropriate on an individualized basis (eg, with the use of epidural analgesia or with fetal malposition) as long as progress is being documented.

 

US Cesarean Section Rate

http://www.acog.org/About_ACOG/News_Room/News_Releases/2014/Nations_Ob-Gyns_Take_Aim_at_Preventing_Cesareans#.UwVmSsS6jlU.facebook

Guidelines Diagnosis and Treatment of Fetal Cardiac Disease

A greater than 1 % absolute risk for having a child with congenital heart disease or a fetal arrhythmia are Indications for referral for fetal echocardiogram according to the  guidelines by the American Heart Association .

The guidelines also outline the elements of the fetal echocardiographic examination, and provide guidance on In utero management of bradycardias and tachycardias .

http://circ.ahajournals.org/content/129/21/2183.long

Donofrio MT, et. al., Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association.Circulation. 2014 May 27;129(21):2183-242. PMID: 24763516

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Pregnant Women with Health Problems Need Care, Not Incarceration

Washington, DC — Throwing pregnant women in jail or involuntarily committing them to mental health facilities for alcohol and drug abuse problems is ineffective and counterproductive, according to a new committee opinion released today by The American College of Obstetricians and Gynecologists (The College). Physicians should instead work with state legislators to retract punitive mandatory reporting laws and replace them with evidence-based strategies outside the legal system to help pregnant women with addictions.

Dental X-Rays, Teeth Cleanings = Safe During Pregnancy

Washington, DC — Teeth cleanings and dental X-rays are safe for pregnant women, according to new recommendations issued by The American College of Obstetricians and Gynecologists (The College). Ob-gyns are now being advised to perform routine oral health assessments at the first prenatal visit and encourage their patients to see a dentist during pregnancy.

ACOG Revises Opinion on Cord Blood Banking

Washington, DC — Physicians should give balanced information to their pregnant patients who are considering cord blood banking, presenting both the advantages and disadvantages of public vs. private cord blood banks, according to The American College of Obstetricians and Gynecologists (ACOG) in a revised Committee Opinion published today in the February issue of Obstetrics & Gynecology. ACOG also advises physicians who recruit patients for for-profit cord blood banking to disclose their financial interests or other potential conflicts of interest to pregnant women and their families.

Routine Screening for Hereditary Breast and Ovarian Cancer Recommended

Washington, DC — Evaluating a patient’s risk of hereditary breast and ovarian cancer syndrome is an important first step in cancer prevention and early detection and should be a routine part of ob-gyn practice. Those who are likely to have the syndrome should be referred for further assessment to a clinician with expertise in genetics, according to a new Practice Bulletin jointly released today by The American College of Obstetricians and Gynecologists and the Society of Gynecologic Oncologists. The new document also provides information on how to counsel patients with hereditary risk in cancer prevention and how to perform surgical removal of the ovaries and fallopian tubes in this population.

Air Travel Safe for Most Pregnant Women

Washington, DC — As long as pregnant women don’t have any obstetric or other medical complications, they can follow the same precautions for air travel as the general population and fly safely, according to a revised Committee Opinion released today by The American College of Obstetricians and Gynecologists (ACOG) and published in the October issue of Obstetrics & Gynecology.

ACOG Refines Fetal Heart Rate Monitoring Guidelines

Washington, DC — Refinements of the definitions, classifications, and interpretations of fetal heart rate (FHR) monitoring methods were issued today in new guidelines released by The American College of Obstetricians and Gynecologists (ACOG). The objective of the guidelines is to reduce the inconsistent use of common terminology and the wide variability that sometimes occurs in FHR interpretations. ACOG’s Practice Bulletin, published in the July 2009 issue of Obstetrics & Gynecology, supports the recommendations of the Eunice Kennedy Shriver National Institute of Child and Health Development workshop* on electronic fetal monitoring (EFM) held in April 2008.