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Committee on Obstetric Practice

Publications and source records attributed to Committee on Obstetric Practice.

11 recordsLinked to original sources
PubMed2006

The Apgar score.

The Apgar score provides a convenient shorthand for reporting the status of the newborn infant and the response to resuscitation. The Apgar score has been used inappropriately to predict specific neurologic outcome in the term infant. There are no consistent data on the significance of the Apgar score in preterm infants. The Apgar score has limitations, and it is inappropriate to use it alone to establish the diagnosis of asphyxia. An Apgar score assigned during resuscitation is not equivalent to a score assigned to a spontaneously breathing infant. An expanded Apgar score reporting form will account for concurrent resuscitative interventions and provide information to improve systems of perinatal and neonatal care.

Apgar Score↗
PubMed2002

ACOG committee opinion. Mode of term singleton breech delivery. Number 265, December 2001. American College of Obstetricians and Gynecologists.

Recently, researchers conducted a large, international multicenter randomized clinical trial comparing a policy of planned cesarean birth with planned vaginal birth. Given the results of this exceptionally large and well-controlled clinical trial, the American College of Obstetricians and Gynecologists Committee on Obstetric Practice recommends that obstetricians continue their efforts to reduce breech presentations in singleton gestations through the application of external cephalic version whenever possible. As a result of the findings of the study, planned vaginal delivery of a term singleton breech may no longer be appropriate. In those instances in which breech vaginal deliveries are pursued, great caution should be exercised. Patients with persistent breech presentation at term in a singleton gestation should undergo a planned cesarean delivery. A planned cesarean delivery does not apply to patients presenting in advanced labor with a fetus in the breech presentation in whom delivery is likely to be imminent or to patients whose second twin is in a nonvertex presentation.

Breech Presentation↗
PubMed2002

ACOG committee opinion. Placenta accreta. Number 266, January 2002. American College of Obstetricians and Gynecologists.

The incidence of placenta accreta has increased 10-fold in the past 50 years and now occurs with a frequency of 1 per 2,500 deliveries. Women who have had two or more cesarean deliveries with anterior or central placenta previa have nearly a 40% risk of developing placenta accreta. If the diagnosis or strong suspicion of placenta accreta is formed before delivery, the patient should be counseled about the likelihood of hysterectomy and blood transfusion. Blood products and clotting factors should be available. Cell saver technology should be considered if available as well as the appropriate location and timing for delivery to allow access to adequate surgical personnel and equipment. A preoperative anesthesia assessment should be obtained.

Female↗
PubMed2002

ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed2002

Management of asymptomatic pregnant or lactating women exposed to anthrax.

Anthrax infections are diagnosed by isolating Bacillus anthracis from body fluids or by measuring specific antibodies in the blood of persons suspected to have the disease. It is recommended that asymptomatic pregnant and lactating women who have been exposed to a confirmed environmental contamination or a high-risk source as determined by the local Department of Health (not the women's health care provider) receive prophylactic treatment. A variety of antimicrobial regimens are available. Although some of these drugs may present risks to the developing fetus, these risks are clearly outweighed by the potential morbidity and mortality from anthrax. Guidelines for prophylactic treatment of anthrax and treatment of suspected active cases of anthrax are changing continually, and the Centers for Disease Control and Prevention web site should be consulted for the latest recommendations.

Anthrax↗
PubMed2002

Analgesia and cesarean delivery rates.

Various studies report conflicting data with regard to the level of risk of cesarean delivery for nulliparous women who receive epidural analgesia before 5 cm of cervical dilatation. As a result, some institutions are requiring that laboring women reach 4-5 cm of dilatation before receiving epidural analgesia. The American College of Obstetricians and Gynecologists wishes to reaffirm the opinion published jointly with the American Society of Anesthesiologists that while under a physician's care, in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor Decisions regarding analgesia should be coordinated among the obstetrician, the anesthesiologist, the patient, and support personnel.

Analgesia, Epidural↗
PubMed2002

Induction of labor for vaginal birth after cesarean delivery.

A recent population-based study of vaginal birth after cesarean delivery (VBAC) attempts observed uterine rupture rates of 24.5 per 1,000 with prostaglandin-induced labor, while the uterine rupture rates with spontaneous labor and labor induced without prostaglandins were lower (5.2/1,000 and 7. 7/1,000 respectively). The authors did not confirm the diagnoses by examining individual medical records, so the actual incidence of uterine rupture may have been overstated. Despite this limitation, the Committee on Obstetric Practice concludes that the risk of uterine rupture during VBAC attempts is substantially increased with the use of various prostaglandin cervical ripening agents for the induction of labor, and their use for this purpose is discouraged.

Cesarean Section↗
PubMed2002

ACOG committee opnion: antenatal corticosteroid therapy for fetal maturation.

The National Institute of Child Health and Human Development and the Office of Medical Applications of Research of the National Institutes of Health convened consensus conference in 1194 and 2000 that recommended giving a single course of corticosteriods to all pregnant women between 24 and 34 weeks of gestation who are at risk of preterm delivery within 7 days. Because of insufficient scientific evidence, the consensus panel also recommended that repeat corticosteroid courses, including so-called "rescue therapy," should not be routinely used but should be reserved for women enrolled in clinical trials. Betamethasone and dexamethasone have been most widely studied and have generally been the preferred corticosteroids for antenatal treatment to accelerate fetal organ maturation. The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice supports the conclusions of the consensus conferences.

Betamethasone↗
PubMed2001

ACOG committee opinion: number 265, December 2001. Mode of term single breech delivery.

Recently, researchers conducted a large, international multicenter randomized clinical trial comparing a policy of planned cesarean birth with planned vaginal birth. Given the results of this exceptionally large and well-controlled clinical trial, the American College of Obstetricians continue their efforts to reduce breech presentations in singleton gestations through the application of external cephalic versions whenever possible. As a result of the findings of the study, planned vaginal delivery of a term singleton breech may no longer be appropriate. In those instances in which breech vaginal deliveries are pursued, great caution should be exercised. Patients with persistent breech presentation at term in a singleton gestation should undergo a planned cesarean delivery. A planned cesarean delivery does not apply to patients presenting in advanced labor imminent or to patients whose second twin is in a nonvertex presentation.

Breech Presentation↗