Trimming preterm deliveries

Staying in the womb until 39 weeks of gestation can make a big difference in a baby's life.

Thankfully, that discovery is making its way into the everyday practice of medicine,  according to papers presented at the recent meeting in New Orleans of the American College of Obstetricians and Gynecologists.Pregnant Graffiti

Almost two-thirds of the country's hospitals with a registered labor and delivery unit have put policies in place  to discourage births before 39 weeks, according to a new study conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania.

Researchers contacted all 2,641 U.S. hospitals with LD departments, and heard back from 2,367 of them. Two thirds of responding hospitals have such a policy.

Sixty-nine percent of those reported that they strictly enforced the policy, the study's authors reported. More than half (53%) of the hospitals that do not have a policy in place to discourage births before 39 weeks said "not medically indicated births" before term went against their standard of care.

In March, ACOG reminded physicians and hospitals that babies should not be delivered before 39 weeks gestation without a good medical reason. Serious ealth risks, and even higher mortality rates, have been established for babies born even in the 37th and 38th weeks of gestation.

The results of the Penn study "show that most hospitals do recognize the issues with early elective delivery, or non-medically indicated delivery prior to 39 weeks, and are adopting policies to prevent the practice,” said Nathaniel G. DeNicola, MD, Robert Wood Johnson Clinical Scholar at  Perelman, and lead author on the study.

Pregnant Graffiti by Petteri Sulonen

ACOG: Still down on home births

The American College of Obstetricians and Gynecologists came out once again this week cautioning against home births.

Hospitals and birthing centers are the safest place for labor and delivery, the speciality organization of obstetricians stated in a committee opinion on Thursday.

A prior Cesarean delivery "is an absolute contraindication to planning a home birth due to the risks, including uterine rupture," the statement said. Twins, breech babies and pregnancies that have gone beond 42 weeks are not good candidates either — too risky for the babies, ACOG said.

"Home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior Cesarean deliveries," said Richard N. Waldman MD, ACOG's president.

This is the latest in a long line of statements the group has made cautioning against the less than 1 percent of  American births that take place at home.

Even so, ACOG does want women to know that if they decide to deliver their babies at home, they should get the "standard components of prenatal care, including Group B strep screening and treatment, genetic screening, and HIV screening."

And, they should work with a birth attendant who is part of "an integrated and regulated health system, have ready access to consultation, and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency," the statement said.

The latest edition of doctors’ book on birth

Often, the annual meeting of a medical group produces a flurry of scientific papers, but the meeting of the American College of Obstetricians and Gynecologists seems more like, say, a bunch of writers  getting together. (I attended the 2009 meeting in Chicago.) As a cohort, OB-GYNs seem to want to find out about the newest approaches, tools and techniques they might put to use in their practices, and perhaps exchange some stories from the trenches as well.

Happy babyBut here's something new for consumers from ACOG, which held its annual meeting in San Francisco this week. The fifth edition of Your Pregnancy and Childbirth: Month to Month was unveiled, along with a new companion website,  www.yourpregnancyandchildbirth.com.

While there are many pregnancy books, this one is "unique in the extent of the medical detail that it covers about all aspects of pregnancy, yet it is designed as an easy-to-read, helpful reference for all of those questions that inevitably pop up," said Hal Lawrence, MD, The College's vice president of practice activities in a press release on the ACOG website.

The latest edition of the book has a new chapter that addresses obesity and eating disorders, another devoted to diabetes during pregnancy, and a third covering other chronic diseases like hypertension, heart disease, celiac disease, lupus, and physical and mental disabilities.

"The majority of women do not experience severe complications, but we felt it was important to give a thorough overview so women will know if something's wrong and when to call a doctor," Dr. Lawrence said.

Another new chapter covers feeding the baby, and includes advice on both breastfeeding and the use of formula.

Specialists in women and babies

The American College of Obstetricians and Gynecologists was founded in Chicago in 1951, the latest in a line of associations that has sought to serve the organizational needs of specialists in medicine for women.

By the time the organization was founded, the controversy over whether the two specialties should be practiced separately or together had been largely resolved, which reflected an improvement of the status of obstetrics. (One 19th century proponent of keeping the two disciplines together had characterized obstetrics as "the portal to the temple of gynecology.")

Obstetricians are not the only doctors who deliver babies — family physicians attend about 20 percent of births nationally, and midwives, mostly nurse-midwives, handled about 8 percent of births in 2004. Still, obstetricians deliver the majority of American babies.

ACOG membership is voluntary. The group, now headquartered in Washington, D.C., has 52,000 members, more than 90 percent of board-certified OB-GYNs. Important ACOG activities include the annual meeting, continuing education and the publication of the monthly journal Obstetrics and Gynecology, the so-called Green Journal.

Some of  ACOG's members are specialists in maternal-fetal medicine, gynecologic oncology, reproductive endocrinology, and other areas.

At least the acronym still works: ACOG

The American College of Obstetricians and Gynecologists begins its annual clinical meeting today in San Francisco. And so, I guess, does the American Congress of Obstetricians and Gynecologists.

Where there was one organization, there now are two, and confusion abounds. I gather that even some ACOG members and staffers aren't sure exactly where the College leaves off and the Congress starts.

Here's "the basic explanation" I got from ACOG's press office when I inquired about the new name on the ACOG website:

The College and the Congress are two separate and distinct legal entities, although they are companion organizations.

The American College of Obstetricians and Gynecologists is a 501(c)(3) organization and its activities include producing the College's practice guidelines and other educational material.

The American Congress of Obstetricians and Gynecologists is a new 501(c)(6) organization that was formed December 31, 2008 and is operational as of January 1, 2010. The Congress focuses on socioeconomic, political, and grievance activities for its members.