American College of Obstetricians and Gynecologists
View all recommendations from this societyReleased February 21, 2013
Don’t treat patients who have mild dysplasia of less than two years in duration.
Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
As a national medical specialty society, the American College of Obstetricians and Gynecologists relies on the input of any number of its committees in the development of various documents. In the case of the items submitted for the Choosing Wisely® campaign, input from the following committees was solicited: the Committees on Patient Safety and Quality Improvement; Obstetric Practice; and Gynecologic Practice. A literature search was conducted related to the initial list of approximately ten items. We then sent this list to the College’s Executive Board and asked them to select five of the items based on their potential to improve quality and reduce cost. We explained to them that the items were written to avoid complex or clinical terminology, but not at the risk of reducing the value and credibility of the recommendations made. In the case of the first two items on our list – “Don’t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age” and “Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable” – we collaborated with the American Academy of Family Physicians in developing the final language. A list of the second set of “five items” was selected by the Committee on Patient Safety and Quality Improvement before submission to the College’s Executive Board for approval. Any comments received from the Executive Board were incorporated into the final list that was approved.
The College’s disclosure and conflict of interest policy can be found at www.acog.org.
Sources
2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcionoma in situ. Wright TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D. Am J Obstet Gynecol. 2007;197:340-45.
Management of abnormal cervical cytology and histology. Practice Bulletin No. 99. American College of Obstetricians and Gynecologists. Obstet Gynecol [Internet]. 2008 Dec;112(6):1419–44.
