Committee on Practice Bulletins-Obstetrics.

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Inherited thrombophilias are associated with an increased risk of venous thromboembolism and also have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy.

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Asthma is a common, potentially serious medical condition that complicates approximately 4-8% of pregnancies. In general, the prevalence of and morbidity from asthma are increasing, although asthma mortality rates have decreased in recent years. The purpose of this document is to review the best available evidence about the management of asthma during pregnancy.

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Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor contributing to perinatal morbidity and mortality (1, 2). Despite extensive research in this area, the rate of preterm birth has increased by 38% since 1981 (3). Premature rupture of membranes (PROM) is a complication in approximately one third of preterm births. It typically is associated with brief latency between membrane rupture and delivery, increased potential for perinatal infection, and in utero umbilical cord compression...

The hemoglobinopathies are a heterogeneous group of single-gene disorders that includes the structural hemoglobin variants and the thalassemias. More than 270 million people worldwide are heterozygous carriers of hereditary disorders of hemoglobin, and at least 300,000 affected homozygotes or compound heterozygotes are born each year. The purpose of this document is to review the most common hemoglobinopathies and to provide recommendations for screening and clinical management of hemoglobinopathies during pregnancy...

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Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States (1,2). However, there is confusion about the terminology and classification of these disorders. This bulletin will provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (ie, preeclampsia and eclampsia), as well as the various associated complications. Chronic hypertension has been discussed elsewhere (3).

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Neural tube defects (NTDs) are congenital structural abnormalities of the brain and vertebral column that occur either as an isolated malformation, along with other malformations, or as part of a genetic syndrome. Isolated (ie, nonsyndromic) NTDs occur in 1.4-2 per 1,000 pregnancies and are the second most common major congenital anomaly worldwide (cardiac malformations are first). In the United States, approximately 4,000 fetuses are affected each year of which one third are either aborted or spontaneously lost...

Bilateral tubal sterilization and vasectomy are both safe and effective permanent methods of contraception; more than 220 million couples worldwide use them as their contraceptive method of choice. Sterilization continues to be the most commonly used contraceptive method in the United States, with 11 million U.S. women relying on the method. Approximately 700,000 tubal sterilizations and 5000,000 vasectomies are performed in the United States annually. The purpose of this document is to review the evidence for the safety and effectiveness of sterilization in comparison with other forms of contraception, as well as evidence of the likelihood that a woman will regret having had a sterilization procedure...

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Preterm birth is the leading cause of neonatal mortality in the United States, and preterm labor precedes 40-50% of preterm births. Preterm birth accounts for 35% of all U.S. health care spending for infants and 10% of all such spending for children. Approximately 467,000 live births annually (11.5% of all live births) occur before term in the United States, and preterm births are responsible for three quarters of neonatal mortality and one half of long-term neurologic impairments in children. The purpose of this document is to present the various methods proposed to manage preterm labor and the evidence for their roles in clinical practice...