5 Practices to Question in Maternal-Fetal Medicine

Larry Hand

February 06, 2014

The Society for Maternal-Fetal Medicine has released its list of the top 5 common practice procedures that may not be necessary, offering clinicians recommendations on what not to do in certain situations. The evidence-based recommendations are a part of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation.

The recommendations are:

  1. "Don't do an inherited thrombophilia evaluation for women with histories of pregnancy loss, intrauterine growth restriction (IUGR), preeclampsia and abruption." Scientific data are lacking for a causal association, and when clinically indicated, testing for antiphospholipid antibodies should be limited to lupus anticoagulant, anticardiolipin antibodies, and beta 2 glycoprotein antibodies.

  2. "Don't place a cerclage in women with short cervix who are pregnant with twins." Scientific data show that in this situation, the procedure is not beneficial and may be associated with an increase in preterm births.

  3. "Don't offer noninvasive prenatal testing (NIPT) to low-risk patients or make irreversible decisions based on the results of this screening test." Utility of NIPT remains unclear for low-risk pregnancies.

  4. "Don't screen for [IUGR] with Doppler blood flow studies." Studies have produced inconsistent results on this, and no standards exist for optimal determination of an abnormal test. If IUGR is detected, however, antenatal fetal surveillance may be beneficial.

  5. "Don't use progestogens for preterm birth prevention in uncomplicated multifetal gestations." Research has not shown that use of progestogens reduces incidence in this situation.

Choosing Wisely, launched in April 2012, is a national campaign involving more than 50 medical specialty societies identifying common medical tests and procedures that may not necessarily benefit patients. The societies, which represent more than 500,000 physicians, have developed lists of "Five Things Physicians and Patients Should Question."

The lists are evidence-based and are designed to help physicians and patients discuss what tests and procedures may not be necessary on an individual basis.


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