The American College of Obstetricians and Gynecologists (ACOG) held its annual clinical and scientific meeting in April 2018 in Austin, Texas. It was encouraging to see that woman-centered care and disparities related to health were part of this year’s conversation.
In addition to disparities, the meeting addressed family planning services and postpartum contraception risk-management. Presentations and discussions centered around underlying causes and prevention of maternal mortality as well as the growing knowledge base and recommendations for cervical and breast cancer screening and treatment.
The focus on women’s preferences, values and goals—such as shared decision making, preference-sensitive care and non-directive counseling—in addition to medical knowledge and evidence, prioritizes well-woman care and applies to emerging areas of work in low- and middle-income countries.
In the United States (U.S.), the risk of pregnancy-related death for black women is three-to-four times higher than that of white women. As such, we were pleased that there was deep analysis of the social determinants of health by socioeconomic background, race and age. ACOG is a leader in developing guidelines and protocols in the U.S., and it is promising to see positive results in maternal outcomes and improvement in health services for women who continue to receive poor quality care. ACOG is now expanding its program and adapting its guidelines and protocols to address the specific issues found in low-resource settings, including rural and urban areas of poverty in the U.S.
Family planning risk-management
When it comes to providing a contraceptive method to women, and adolescents in particular, ACOG encourages clinicians to consider the benefit of providing a contraceptive method immediately (preventing unintended pregnancy) and not to postpone contraception while waiting for test results or gynecological examination. If there are no evident contraindications, its new guidance suggests that providing contraception at the time a young woman asks for it is preferable. This is a significant step for women, and we hope providers adjust their protocols using these new recommendations.
Postpartum family planning
Postpartum family planning was emphasized as a way to reduce maternal mortality and morbidity. There are a variety of options available. For example, as long-acting methods such as the intrauterine device (IUD) have become more acceptable for providers and women over the last few years, and postpartum insertion proven safe and effective, more obstetricians and gynecologists are being trained in the method. There has also been increased advocacy for the method, and insurance companies in some states are now covering the cost of a second IUD after the first is expelled postpartum.
As previously stated, there are concerns related to the World Health Organization’s weak recommendation of the use of tranexamic acid for the treatment of postpartum hemorrhage (PPH). ACOG supported treating PPH with misoprostol and oxytocin. The title of one of the sessions, Rethinking Postpartum Hemorrhage Management: The role of Simple Technologies in Expanding Access to PPH Management, emphasized continued use of proven treatments.
We are pleased that ACOG continues to evolve on issues from social determinants of health to guidelines that meet women and girls’ immediate needs. The information shared at the ACOG meeting is very useful for agencies working to improve maternal health in the U.S. and globally.