With Routine Medical Tests and Procedures, Choose Wisely

Hal C. Lawrence III, MD, ACOG Vice President, speaking during the press briefing.

Hal C. Lawrence III, MD, ACOG Executive Vice President, speaking during the press briefing.

Open lines of communication are the basis of successful doctor-patient interactions. However, when it comes to medical tests and procedures, doctors and patients alike can easily slide into cruise control without taking the time to discuss what’s truly needed, appropriate, supported by evidence-based research, and in the best interest of the patient’s care.

With this in mind, ACOG has teamed up with the Choosing Wisely campaign—an initiative that aims to spark a conversation about commonly performed tests and exams in different areas of medicine. By taking a critical eye to routine health care practices, we can make better decisions on how to provide thorough and comprehensive care while avoiding unnecessary, redundant, or even risk-increasing procedures.

Today, at a joint press conference with 16 other partnering organizations, ACOG made the following recommendations:

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

3. Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age.
In average–risk women, annual cervical cytology screening has been shown to offer no advantage over screening performed at 3-year intervals. However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems and to have appropriate screening with consideration of a pelvic examination.

4. Don’t treat patients who have mild dysplasia of less than two years in duration.
Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average–risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment.

5. Don’t screen for ovarian cancer in asymptomatic women at average risk.
In population studies, there is only fair evidence that screening of asymptomatic women with serum CA-125 level and/or transvaginal ultrasound can detect ovarian cancer at an earlier stage than can be detected in the absence of screening. Because of the low prevalence of ovarian cancer and the invasive nature of the interventions required after a positive screening test, the potential harms of screening outweigh the potential benefits.

Learn more.

A Healthy Weight for Pregnancy

It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.