Wednesday, May 2, 2018

News from ACOG: Redefining the “Fourth Trimester of Pregnancy” as a Gateway to Long-Term Health


The President’s Program at the opening of ACOG annual conference in Austin, Texas stressed the importance of comprehensive pregnancy care that should extend well beyond the third trimester and labor into period 3 months post-delivery, rightly called as “the fourth trimester”.

Keeping with this year theme of “Medical and Surgical Innovations in Health Care,” the President’s program was not three separate lectures but a ‘President Panel’ that included 3-star speakers discussing “The New Postpartum Visit: Beginning of Lifelong Health.”

Dr. Brown opined that ob-gyns are the primary doctors that most women see for the bulk of care throughout their lives and we must make it sure that we also meet her additional healthcare needs beside pregnancy and gynecology care.

Postpartum care was always in focus throughout Dr. Brown’s tenure as ACOG President. The task force on “Redefining the Postpartum Visit” and ACOG Committee on Obstetric Practice have released a revised “Optimizing Postpartum Care” Committee Opinion published in the May issue of Obstetrics & Gynecology.

ACOG previously recommended that all women should have a comprehensive health check-up visit within the first 6 weeks after birth, now ACOG recommends that post-partum care is an ongoing process and women should stay in contact with their obstetrician or other obstetric care provider for the first three weeks after birth.

This close contact with the obstetrician is especially important for elderly mothers and women with chronic diseases. The initial visits should culminate into a comprehensive individualized post-partum visit at 12 weeks that includes a full assessment of:

  • Mood and emotional well-being
  • Infant care and feeding
  • Physical recovery from birth
  • Physical intimacy, spacing and contraception
  • Sleep and fatigue
  • Chronic disease management
  • General health maintenance


Early follow-up is also important for women who had cesarean section, perineal lacerations, lactational difficulties or postpartum depression.

Mothers who had any superimposed medical problems gestational diabetes mellitus or hypertensive disorders or had a preterm labor should undergo special counselling about the increased risk of these disease later in life.

Those women who have had a pregnancy mishap also benefit from early visit in terms of emotional support and counselling and referrals as needed for future risk of such mishap.

It is known that one half of postpartum strokes occur within 10 days of discharge, hence women with hypertensive disorder of pregnancy should have the first follow-up within 7-10 days and those with severe hypertension should be in within 72 hours to evaluate the status of blood pressure.

The postpartum visit at 12 weeks serves as a transition towards the ongoing well-women care. The obstetric care provider should initiate communication with the patients’ primary care provider regarding the medical problems faced by her in pregnancy and the future implications of such problems on the woman’s long-term health.

Currently, about 40% of women do not come for a follow-up visit and important opportunities for contraception counselling and spacing and treatment of chronic health condition is lost.

“New mothers need ongoing care during the ‘fourth trimester.’ We want to replace the one-off checkup at six weeks with a period of sustained, holistic support for growing families,” said Alison Stuebe, M.D., lead author of the Committee Opinion. “Our goal is for every new family to have a comprehensive care plan and a care team that supports the mother’s strengths and addresses her multiple, intersecting needs following birth.”

Dr Brown added “This revised guidance is important because the new recommended structure is intended to consider and cater to the postpartum needs of all women, including those most at risk of falling out of care.”




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