Ob/Gyn & Women's Health Practice Guidelines


General Health



This report provides recommendations regarding public health surveillance and research on violence against women developed during a workshop,"Building Data Systems for Monitoring and Responding to Violence Against Women." The Workshop, which was convened October 29--30, 1998, was co-sponsored by the U.S. Department of Health and Human Services and the U.S. Department of Justice.
SOURCE: MMWR 49(No. RR-11), 2000


This is the first national, multispecialty, comprehensive routine screening document on domestic violence. In addition to specific guidelines for primary care, ob-gyn, family planning, urgent care, mental health, and inpatient settings, these guidelines include an extensive bibliography and documentation forms.
SOURCE: Family Violence Prevention Fund, 1999


Every adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
SOURCE: JAMA 273, 1995


Moderate levels of physical activity confer significant health benefits. Even those who currently meet these daily standards may derive additional health and fitness benefits by becoming more physically active or including more vigorous activity.
SOURCE: NIH Consensus Statement 13(3), 1995


This publication focuses on some of the specific issues affecting women's health: falls and resulting hip fractures, sports injuries, breast and cervical cancer, and congenital toxoplasmosis.
SOURCE: MMWR 49(No. RR-2), 2000


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Reproductive Health and Family Planning

The objective of these guidelines is to develop a screening tool to evaluate appropriateness of requests for elective abdominal, vaginal, and laparoscopic hysterectomy.
SOURCE: Optimed Medical Systems, 1999, Lexington, MA


The objectives of these guidelines are to deliver the highest quality of care for both mother and infant, to ensure all necessary education and labs are performed at the appropriate times, and to accomplish these objectives in the most time- and cost-efficient manner for both patient and physician.
SOURCE: Kaiser Permanente, Rockville, MD, 1997


The Charter provides an ethical framework for IPPF's work in the field of sexual and reproductive health and rights.
SOURCE: International Planned Parenthood Federation, 2000


This Family Health International training module is designed to increase the awareness and understanding about the reproductive health needs of young adults among policy makers, program directors, program planners, and healthcare providers and to enable these audiences to provide more adequate health services to youth.
SOURCE: Family Health International, 1999


This document summarizes key findings about the health benefits of family planning and explains how offering a choice of contraceptive methods benefits both clients and programs. It is intended for policy makers, program managers, community leaders, teachers, and healthcare providers.
SOURCE: World Health Organization, 1999


Women older than 35 years constitute at least 20% of contraceptive users. They need special consideration because pregnancy in this age group carries greater health hazards for mother and baby.
SOURCE: International Planned Parenthood Federation, 1997


Genetic testing for CF should be offered to adults with a positive family history of CF, to partners of people with CF, to couples currently planning a pregnancy, and to couples seeking prenatal care.
SOURCE: NIH Consensus Statement 15 (4), 1997


These guidelines are designed for managers of abortion treatment facilities, family planning programs, and induced abortion services.
SOURCE: World Health Organization, 1997


Female sterilization is the most widely used family planning method in the world and one of the most effective. This document provides answers to the most common questions about female sterilization.
SOURCE: World Health Organization, 1999


Quality reproductive health services must be based on refugees', particularly women refugees', needs. They must also respect refugees' various religious and ethical values and cultural backgrounds while conforming to universally recognized international human rights standards.
SOURCE: International Planned Parenthood Federation, 1999


This report aims to provide a practical framework, which family planning associations and clinic personnel can use to combat gender-based violence.
SOURCE: International Planned Parenthood Federation, 1999


At the community and national level, family planning associations have an important role to play in the eradication of female genital mutilation.
SOURCE: International Planned Parenthood Federation, 1991


Family planning programs are well placed to help in the prevention of STDs by providing accurate and understandable information, advocating low-risk sexual behavior, and promoting the use of condoms.
SOURCE: International Planned Parenthood Federation, 1997


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Sexually Transmitted Diseases

Included in these updated guidelines are new alternative regimens for bacterial vaginosis; an expanded section on the diagnosis of genital herpes; a revised approach to the management of victims of sexual assault; and inclusion of hepatitis C as a sexually transmitted infection. In addition, these guidelines emphasize education and counseling for persons infected with human papillomavirus and clarify the diagnostic evaluation of congenital syphilis.


The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection.
SOURCE: U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, 2001


DHHS guidelines for a multidisciplinary approach to the prevention and treatment of substance abuse in HIV-infected individuals.
SOURCE: DHHS Public Health Service. Substance Abuse and Mental Health Services Administration: Center for Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, 2000.


Included are new recommendations for treatment of primary and recurrent genital herpes and management of pelvic inflammatory disease, a new patient-applied medication for treatment of genital warts, and a revised approach to the management of victims of sexual assault. Revised sections describe the evaluation of urethritis and the diagnostic evaluation of congenital syphilis. These guidelines also include expanded sections concerning STDs in infants, children, and pregnant women and the management of patients who have asymptomatic HIV infection, genital warts, and genital herpes. Guidelines are provided for vaccine-preventable STDs, including recommendations for the use of hepatitis A and hepatitis B vaccines.
SOURCE: MMWR 47(RR-1), 1998


The ACHSP recommends that early detection and treatment of curable STDs should be implemented more widely as an HIV prevention strategy in the United States.
SOURCE: MMWR 47(RR-12), 1998


The United States Preventive Services Task Force Routine recommends screening for Chlamydia trachomatis infection in all sexually active female adolescents, high-risk pregnant women, and other asymptomatic women at high risk of infection.
SOURCE: Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams & Wilkins, 1996


This report provides comprehensive guidelines to achieve PID prevention and management objectives. The main focus of this document is PID related to sexually transmitted disease.
SOURCE: MMWR 40(RR-5), 1991


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Pregnancy & Childbirth

Clinicians should consider previous history of preterm delivery, other risk factors, and time of presentation in making the decision whether or not to screen for BV in women at high risk.
SOURCE: U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, 2001


Complications arising from pregnancy and childbirth cause the deaths of more than half a million women every year and leave many others with serious and lifelong health problems. This joint statement delivers key messages that draw on lessons learned and experience gained by countries worldwide in their efforts to reduce and prevent maternal deaths.
SOURCE: World Health Organization, 1999


Maternal mortality is a crucial though complex measure of a country's overall health and development status. Few developing countries have been able to establish comprehensive reporting needed; even where such vital registration systems are in place, maternal deaths are often underreported or misclassified as nonmaternal.
SOURCE: World Health Organization, 1997


This guide is intended to assist health workers in preventing death and serious injury from abortion complications.
SOURCE: World Health Organization, 1997


Tobacco smoking is associated with adverse pregnancy outcomes, which may be preventable through smoking cessation interventions.
SOURCE: Canadian Task Force on Preventive Health Care, 1994


To date, the only readily available screening strategy for preeclampsia is the early detection of an abnormal blood pressure trend over time.
SOURCE: Canadian Task Force on Preventive Health Care, 1994


Screening for preeclampsia with blood pressure measurement is recommended for all pregnant women at the first prenatal visit and periodically throughout the remainder of pregnancy.
SOURCE: Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams & Wilkins, 1996


D (formerly Rh) blood typing and antibody screening is recommended for all pregnant women at their first prenatal visit. Repeat antibody screening at 24-28 weeks' gestation is recommended for unsensitized D-negative women.
SOURCE: Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams & Wilkins, 1996


This report describes CVS and amniocentesis, provides information on indications for their use, reviews studies about the safety of the procedures, compares the benefits and risks of the 2 procedures (focusing particularly on the risk for limb deficiency after CVS), and provides recommendations for counseling about these issues.
SOURCE: MMWR 44(RR-9), 1995


This report is intended to provide guidance to primary healthcare providers and emphasizes the etiology and epidemiology of iron deficiency, the laboratory tests used to assess iron status, and the screening for and treatment of iron deficiency at all ages.
SOURCE: MMWR 47(RR-3), 1998


The United States Public Health Service recommendation for folic acid supplementation in women of childbearing age who are capable of becoming pregnant to reduce their risk of having a pregnancy affected with spina bifida or other neural tube defects.
SOURCE: MMWR 41(RR-14), 1992


This document, prepared by the American Diabetes Association, describes the recommended intensive outpatient treatment plan, based on risk assessment, health promotion, and intervention, and outlines effective team work strategies to implement the plan before and during early pregnancy.
SOURCE: Diabetes Care 23 (Suppl 1), 2000


Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. This report, prepared by the American Diabetes Association, reviews the definition, detection, and diagnosis of GDM and outlines therapeutic strategies.
SOURCE: Diabetes Care 23 (Suppl 1), 2000


Although many of the recommendations in the 2002 guidelines are the same as those in 1996, they include some key changes.


Group B streptococcus is a leading cause of serious neonatal infection. Intrapartum antimicrobial prophylaxis in women who are at increased risk for transmitting the infection to their newborns can prevent most neonatal GBS infections.
SOURCE: MMWR 45(RR-7), 1996


The Consensus panel concluded that antenatal corticosteroid therapy for fetal maturation reduces mortality, respiratory distress syndrome, and intraventricular hemorrhage in preterm infants.
SOURCE: NIH Consensus Statement 12(2), 1994


Statement on methods that increase the safety of laparoscopy in the pregnant patient.
SOURCE: Society of American Gastrointestinal Endoscopic Surgeons, 1996


There is insufficient evidence to recommend for or against home uterine activity monitoring (HUAM) in high-risk pregnancies as a screening test for preterm labor, but recommendations against its use may be made on other grounds. HUAM is not recommended in normal-risk pregnancies.
SOURCE: Guide to Clinical Preventive Services. 2nd ed. Baltimore: Williams & Wilkins, 1996


Recommendations developed by the Institute for Clinical Systems Improvement aim to prevent unnecessary cesarean sections associated with failure to progress and increase the use of procedures that assist in progress to vaginal birth. The National Guideline Clearinghouse provides a summary of the recommendations.
SOURCE: Institute for Clinical Systems Improvement, 1999


Guidelines and recommendations for antenatal care made by a WHO Technical Working Group in 1996.
SOURCE: World Health Organization, 1999


The American Academy of Pediatrics promotes breastfeeding of infants as the foundation of good feeding practices and healthy development. Their recommendations on breastfeeding practices and the role of pediatricians in promoting and protecting breastfeeding are summarized by the National Guideline Clearinghouse.
SOURCE: Pediatrics 100(6), 1997


Report of a WHO Technical Working Group in 1996.
SOURCE: World Health Organization, 1999


Cord infections and neonatal tetanus contribute significantly to high neonatal mortality rates in developing countries. Recommendations are made for clean cord care.
SOURCE: World Health Organization, 1999


Recommendations developed by the Institute for Clinical Systems Improvement aim to decrease the number of repeat cesarean sections that are not medically indicated, increase the percentage of women who are eligible for vaginal birth after cesarean (VBAC) who attempt VBAC, and increase the percentage of VBAC eligible women who receive education describing risks and benefits of VBAC. The National Guideline Clearinghouse provides a summary of the recommendations.
SOURCE: Institute for Clinical Systems Improvement, 1998


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Aging

Nutrients for which reliable data are available directly from experiments conducted with older persons have been reviewed. Wherever possible,the recommendations that follow take into consideration not only the amount of a nutrient required to prevent a deficiency state but also a chronic disease.


SOURCE: Consensus Opinion of The North American Menopause Society, March 2001


SOURCE: Consensus Opinion of The North American Menopause Society, July 2000


This statement summarizes the U.S. Preventive Services Task Force recommendations for use of hormone replacement therapy for the primary prevention of chronic conditions in postmenopausal women and updates the 1996 USPSTF recommendations on this topic.


SOURCE: Consensus Opinion of The North American Menopause Society, March 2000


SOURCE: Consensus Opinion of The North American Menopause Society, March 2000


Although the needs of women during the perimenopausal phase have been recognized and addressed in most Western cultures, these needs have not been properly addressed in developing countries.
SOURCE: International Planned Parenthood Federation, 1996


The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures. There is insufficient evidence to recommend for or against routine osteoporosis screening in postmenopausal women who are younger than 60 or in women aged 60-64 who are not at increased risk for osteoporotic fractures.


Optimization of bone health is a process that must occur throughout the lifespan in both males and females. Factors that influence bone health at all ages are essential to prevent osteoporosis and its devastating consequences.
SOURCE: NIH Consensus Statement 17 (2), 2000


Osteoporosis and fractures are not a natural consequence of aging. NIH support for clinical studies of nutrition and physical activity interventions has provided strong evidence that fractures can be prevented and bone loss reduced even in older individuals.
SOURCE: National Institute of Arthritis and Musculoskeletal and Skin Diseases Congressional Report, 1998


These guidelines address the prevention, diagnosis, and management of postmenopausal osteoporosis.
SOURCE: American Association of Clinical Endocrinologists, 1996


Increased intake of calcium may help prevent osteoporosis, but a large percentage of Americans fail to meet currently recommended guidelines for optimal calcium intake.
SOURCE: NIH Consensus Statement 12(4), 1994


This report from the Agency for Health Care Policy and Research for UI reviews recommendations for prevention and evaluation, use of behavioral, pharmacologic and surgical treatments, and the long-term management of chronic intractable UI.
SOURCE: Agency for Health Care Policy and Research, Publication No. 96-0682, 1996


A clinical practice guideline on screening for Alzheimer's disease and related dementias.
SOURCE: Agency for Health Care Policy and Research, Publication No. 97-0702, 1996


The workshop recommendations emphasize the need for improved and expanded epidemiologic studies of alcohol consumption patterns and health outcomes and for specific investigations of the relationship between alcohol and cardiovascular disease.
SOURCE: MMWR 38(22), 1989


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Breast and Gynecologic Cancer





This statement provides an assessment of currently available data regarding the effectiveness of mammography screening for women ages 40-49.
SOURCE: NIH Consensus Statement 15(1), 1997


The Kaiser Permanente Health Plan, Inc. Mid-AtlanticPermanente Medical Group - Managed Care Organization has recommendations for genetic counseling referral for women and men who may be at increased risk for developing breast or ovarian cancer because of an alteration in a BRCA gene. A summary of the recommendations is provided by the National Guideline Clearinghouse.
SOURCE: Rockville (MD): Kaiser Permanente, 1998


There is insufficient evidence to recommend for or against routine counseling of women about measures to reduce the risk of cervical, ovarian, and endometrial cancer.
SOURCE: Guide to Clinical Preventive Services. 2nd ed. Baltimore (MD): Williams Amp; Wilkins, 1996


Screening for cervical cancer by regular Pap tests should be performed in all women who are or have been sexually active and should be instituted after a woman first engages in sexual intercourse.
SOURCE: American Journal of Preventive Medicine 12(5), 1996


The statement provides an assessment of current screening, prevention, and treatment approaches to cervical cancer.
SOURCE: NIH Consensus Statement 14(1), 1996


The evidence is insufficient at this time to recommend physical examination, ultrasonography, biochemical markers, or genetic screening for asymptomatic women for early detection of ovarian malignancy.
SOURCE: American Journal of Preventive Medicine 13(6), 1997


There is no evidence that the current screening modalities of CA 125 and transvaginal ultrasonography can be effectively used to reduce mortality from ovarian cancer nor that their use will result in decreased morbidity and mortality.
SOURCE: NIH Consensus Statement 12(3), 1994


The American Society of Colposcopy and Cervical Pathology developed criteria for specimen adequacy of a Pap smear. A summary of the criteria is provided by the National Guideline Clearinghouse.
SOURCE: J Lower Genital Tract Disease 1(2), 1997


The American Society of Colposcopy and Cervical Pathology present 4 options for managing follow-up of atypical squamous cells of undetermined significance. A summary of the guidelines is provided by the National Guideline Clearinghouse.
SOURCE: Colposcopist 27(1), 1996


The American Society of Colposcopy and Cervical Pathology review appropriate management of atypical glandular cells of undetermined significance (AGUS) and cytologic changes suggestive of adenocarcinoma in situ (AIS) or consistent with adenocarcinoma. A summary of the guidelines is provided by the National Guideline Clearinghouse.
SOURCE: J Lower Genital Tract Disease 1(1), 1997


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