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SMFM and Choosing Wisely: The Latest 5 Practices That Doctors and Patients Should Question

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Describe the goal of the Choosing Wisely campaign
2. Discuss the most recent five practices that SMFM advises against

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 7/1/2019 through 7/1/2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

SUMMARY:

The purpose of the Choosing Wisely campaign is to promote discussion between patients and clinicians with the goal of preventing unnecessary medical interventions. SMFM augmented the previous ten Choosing Wisely campaign questions with five additional practices that “Physicians and Patients Should Question” (May 2019). We summarize this most recent set of five practices, and also provide ‘Related ObG Topics’ below. All 15 practices can be found in the ‘Learn More – Primary Sources’ section below, along with related references.

KEY POINTS:

In women with low risk aneuploidy screening results and isolated ‘soft markers’, such as echogenic intracardiac focus (EIF) or isolated choroid plexus cyst (CPC)
- Do not recommend invasive testing
- Describe ‘soft marker’ finding as ‘not clinically significant’ or ‘normal variant’
Following cerclage placement
- Do not perform serial cervical length measurement
- There is no evidence that cervical length monitoring following a cerclage improves outcomes, despite cervical shortening being associated with increased risk for preterm birth
In the clinical evaluation for thrombophilia, recurrent pregnancy loss, or for at-risk family members
- Do not order MTHFR polymorphism genotyping
- Two polymorphic variants are known to decrease enzyme activity: 677C>T and 1298A>C
- Older studies suggested that MTHFR genotype status may be related to increased risk of venous thrombosis, coronary heart disease, recurrent pregnancy loss and adverse pregnancy outcomes but more recent analyses have not demonstrated consistent associations
In pregnant women who are asymptomatic
- Do not screen for subclinical hypothyroidism
- RCTs have not demonstrated treatment benefit for subclinical hypothyroidism
- A recent secondary analysis of a large RCT did not identify a difference between prepregnancy TSH < 2.5 vs ≥5 mIU/L and preterm delivery, GDM or preeclampsia
When making the diagnosis of oligohydramnios in the third trimester
- Do not use AFI | Deepest vertical pocket of <2 is preferred
- AFI is associated with more women being identified with oligohydramnios, but without any significant benefit in perinatal outcome

Learn More – Primary Sources:

SMFM Choosing Wisely: Things Physicians and Patients Should Question

Choosing Wisely®: Promoting conversations between patients and clinicians

SMFM Consult Series 42: The role of ultrasound in women who undergo cell-free DNA screening

SMFM: Cervical cerclage for the woman with prior adverse pregnancy outcome

ACOG Committee Opinion 197: Inherited Thrombophilias in Pregnancy

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SMFM and Choosing Wisely: The Latest 5 Practices That Doctors and Patients Should Question