The New ACOG Choosing Wisely List: What's On It?

    The New ACOG Choosing Wisely List: What's On It?

    4/19/2016 3:32:11 PM

    You’ve likely heard that the American College of Obstetricians and Gynecologists added some new items to its Choosing Wisely list. This list is part of the Choosing Wisely® initiative led by the American Board of Internal Medicine (ABIM) Foundation.

    Nurses and childbirth educators who are knowledgeable and up to date on this list will be better equipped to relay the information to their students and provide them with clear explanations. So, what exactly does the new list include? Read on to find out.

    The 5 New Items
    In March 2016, the ACOG released “Five More Things Physicians and Patients Should Question” in obstetrics-gynecology, which builds on the original "Five Things Physicians and Patients Should Question" released in February 2013.

    The initial ACOG Choosing Wisely list consisted of five items, one of which was the recommendation to not schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks of gestational age.

    The five new items that were recently added are as follows:

    1. Avoid using robotic-assisted laparoscopic surgery for benign gynecologic disease when it’s feasible to use a conventional laparoscopic or vaginal approach.

    According to the ACOG, robotic-assisted laparoscopic surgery results in comparable outcomes to conventional laparoscopic surgeries. The thought is that since robotic-assisted techniques take longer, are more expensive, and produce similar outcomes to other procedures, they should only be performed if truly necessary.

    2. Don’t perform prenatal ultrasounds for non-medical purposes such as to create keepsake videos or photographs.

    Unnecessary ultrasounds are excessive and costly. The Food and Drug Administration (FDA) doesn’t approve the use of ultrasounds without a true medical indication. The American Institute of Ultrasound in Medicine (AIUM) also discourages non-essential ultrasounds.

    3. Don’t routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7 to 8 grams.

    Transfusions bring many potential risks, including infections, allergic and immune reactions, and iron overload, among others. To prevent unnecessary exposure to these risks, the ACOG states, “Arbitrary hemoglobin or hematocrit thresholds should not be used as the only criterion for transfusions.”

    4. Don’t perform pelvic ultrasound in average-risk women to screen for ovarian cancer.

    With 13 ovarian cancer cases reported per 100,000 annually (after an age-adjusted incidence), screening for ovarian cancer has a low positive predictive value and leads to a high rate of false positives. So, without a family history or other risk factors, a pelvic ultrasound performed in asymptomatic women doesn’t reduce deaths and isn’t advised.

    5. Don’t routinely recommend activity restriction or bed rest during pregnancy.

    Physicians have historically advised bed rest for a wide range of pregnancy conditions, but the negative implications of putting women on activity restriction far outweigh the benefits.

    According to Dr. Anthony C. Sciscione, director of Maternal-Fetal Medicine at Christiana Care Health System, the only clinical benefit that has resulted from bed rest has been a modest decrease in blood pressure. He notes the following as risks of activity restriction:

    • Increased maternal anxiety and depression
    • Significant negative financial impact on the family
    • Bone loss
    • Potential increase in blood clots

    Explaining the New ACOG Choosing Wisely List

    Now that you’re more familiar with what this updated list entails, and the reasoning behind each item on the list, you’ll be able to discuss the potential dangers of certain interventions during your classes and confidently address concerns and answer questions from your students.