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Antenatal Corticosteroid Therapy for Fetal Maturation - ACOG
A number of Practice Bulletins also underwent focused changes to support the Committee Opinion. As ACOG continues its commitment to improving and applying the current best practices in obstetrical care, dedicated and focused attention on preterm birth and associated outcomes are an essential component.
In addition to the long-standing recommendation to administer corticosteroids for women between 24 and 34 weeks pregnant anticipated to go into imminent preterm labor, the Committee Opinion includes new recommendations that support the administration of antenatal corticosteroids in certain populations during the late preterm birth period, or between 34 and 37 weeks of gestation.
Recent data have shown that corticosteroids can also have long-term effect on preterm infant outcomes. Data from NICHD Neonatal Research Network indicated a reduction in death and neurodevelopmental impairment in infants months who were born at weeks and whose mothers received antenatal corticosteroids, as compared to similar preterm infants whose mothers did not receive corticosteroids. We must also continue to press for more research evaluating preterm birth therapies among specific populations and long term outcomes.
For more information and resources visit acog. Committee Opinion , Management of Vulvar Intraepithelial Neoplasia Vulvar intraepithelial neoplasia VIN is an increasingly common problem, particularly among women in their 40s. Although spontaneous regression has been reported, VIN should be considered a premalignant condition. Immunization with the quadrivalent or 9-valent human papillomavirus vaccine, which is effective against human papillomavirus genotypes 6, 11, 16, and 18, and 6, 11, 16, 18, 31, 33, 45, 52, and 58, respectively, has been shown to decrease the risk of vulvar high-grade squamous intraepithelial lesion HSIL VIN usual type and should be recommended for girls aged 11—12 years with catch-up through age 26 years if not vaccinated in the target age.
Detection is limited to visual assessment with confirmation by histopathology when needed. Because of the potential for occult invasion, wide local excision should be performed if cancer is suspected, even if biopsies show vulvar HSIL. When occult invasion is not a concern, vulvar HSIL VIN usual type can be treated with excision, laser ablation, or topical imiquimod off-label use. Given the relatively slow rate of progression, women with a complete response to therapy and no new lesions at follow-up visits scheduled 6 months and 12 months after initial treatment should be monitored by visual inspection of the vulva annually thereafter.
Committee Opinion , Health Literacy to Promote Quality of Care Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services they need to make appropriate health decisions. The responsibility for recognizing and addressing the problem of limited health literacy lies with all entities in the health care system, from primary care physicians to community-based or public health organizations.
Because of the potential effect of health literacy on patient outcomes, obstetrician— gynecologists should take the appropriate steps to ensure that they communicate in an understandable manner so patients can make informed decisions about their health care. Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased.
The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV.
In , the rate was By , it decreased to 6. Mortality from the disease has undergone a similar decrease from 5. The American Cancer Society ACS estimated that there would be 12, new cases of cervical cancer in the United States in , with 4, deaths from the disease. Cervical cancer is much more common worldwide, particularly in countries without screening programs, with an estimated , new cases of the disease and , resultant deaths each year.
When cervical cancer screening programs have been introduced into communities, marked reductions in cervical cancer incidence have followed. New technologies for cervical cancer screening continue to evolve, as do recommendations for managing the results. In addition, there are different risk—benefit considerations for women at different ages, as reflected in age specific screening recommendations.