{"title":"Premenstrual Syndrome","authors":"Sarah L. Berga, Jessica B Spencer","doi":"10.2310/obg.1090","DOIUrl":"https://doi.org/10.2310/obg.1090","url":null,"abstract":"Premenstrual syndrome (PMS) is a recurrent constellation of affective and physical symptoms that begin during the luteal phase of the menstrual cycle and resolve completely or almost completely during the follicular phase. Symptoms range in severity from mild to severe. The pathophysiology of PMS is discussed in this chapter, and potential causes are listed in a table. The diagnosis and differential diagnosis are reviewed. To warrant medical attention, evaluation, and intervention, premenstrual symptoms must be recurrent and sufficiently severe to interfere with daily work and social activities. Mild cases of PMS can be treated with lifestyle modification (e.g., good sleep patterns, regular exercise) and nonpharmacologic therapy (e.g., bright-light therapy, stress management, behavioral therapy). More severe cases warrant aggressive intervention, with pharmacologic therapy and even surgery in women who respond very well to a gonadotropin-releasing hormone (GnRH) agonist and have completed childbearing.\u0000\u0000This review contains 1 figure, 5 tables and 51 references\u0000Key Words: Premenstrual syndrome, premenstrual dysphoric disorder, selective serotonin reuptake inhibitors, anxiogenic progesterone metabolites, estrogen, progesterone.","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132085300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Female Pelvic Pain: Assessment","authors":"M. Castellanos, L. King","doi":"10.2310/obg.19012","DOIUrl":"https://doi.org/10.2310/obg.19012","url":null,"abstract":"Chronic pelvic pain (CPP) in women is responsible for greater than 10% of referrals to gynecologists. A majority of them will remain undiagnosed or inadequately treated. Over time, CPP may lead to a syndrome that results in disability, loss of employment, and discord within relationships. This review discusses how to achieve a comprehensive assessment of CPP from a variety of causes.\u0000\u0000This review contains 13 figures, 5 tables and 60 references\u0000Key Words: dysmenorrhea, dyspareunia, endometriosis, interstitial cystitis, irritable bowel syndrome, pelvic floor dysfunction, pelvic pain, pudendal neuralgia, somatic pain, visceral pain","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126800901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dysmenorrhea in the Adolescent","authors":"R. Evans, C. Knill","doi":"10.2310/OBG.19114","DOIUrl":"https://doi.org/10.2310/OBG.19114","url":null,"abstract":"As a common medical issue for adolescents both in the United States and worldwide, dysmenorrhea is a leading cause of visits to primary care providers and gynecologic specialists. The prevalence of dysmenorrhea in women is highest in the adolescent population affecting 20-90% of females in this age group. Primary dysmenorrhea is the most common form of dysmenorrhea and is defined as painful menstruation in the absence of pelvic pathology. Secondary dysmenorrhea is explained by an underlying pathology such as endometriosis or genital tract obstruction. The differential diagnosis of dysmenorrhea includes other etiologies of pelvic pain such as gastrointestinal, genitourinary, or other gynecologic pathologies. Symptoms refractory to first and second line treatments warrant further evaluation and management. As the second most common cause of pelvic pain in adolescents after primary dysmenorrhea, endometriosis may manifest itself differently in adolescents when compared to adults. Non-steroidal anti-inflammatory agents (NSAIDS) are first line medical management for dysmenorrhea. Hormonal agents are second line medical management though are often initiated concomitantly with NSAID therapy. Complex imaging and surgery are reserved for refractory cases of pelvic pain. This document outlines the recommended evaluation and management of adolescents with dysmenorrhea and highlights important medical advances that have contributed to treatment.\u0000 \u0000This review contains 5 figures, 8 tables, and 34 references.\u0000Keywords: dysmenorrhea, pelvic pain, endometriosis, menstruation, menses, Premenstrual Syndrome, tranexamic acid, menstrual suppression, menstrual disorders\u0000 ","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129030510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vaginitis","authors":"Monica Mendiola, Rachel A. Blake","doi":"10.2310/obg.19007","DOIUrl":"https://doi.org/10.2310/obg.19007","url":null,"abstract":"Vulvovaginal complaints are a common indication for women to seek gynecologic care. The most common causes of vaginitis are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, which account for 22 to 50%, 17 to 39%, and 4 to 35% of vaginitis, respectively. This review describes the presentation, diagnosis, and prevention strategies for the most important causes of vulvovaginitis, including characteristic findings on office microscopy and newer available diagnostic testing. It outlines treatment modalities for uncomplicated infections in healthy women, as well as nuances of treatment for recurrent and persistent infections, pregnant women, and HIV-positive women. It also explores the diagnosis and management of non-infectious vaginitis as well special consideration for vaginitis in children and adolescents.\u0000This review contains 4 figures, 11 tables, and 58 references.\u0000Key words: vaginitis, vulvovaginitis, bacterial vaginosis, candidiasis, trichomoniasis, vaginitis treatment","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130413586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abnormal Menstrual Bleeding","authors":"Chu Hsiao, Leanne Dumeny, C. Holliday, L. Spiryda","doi":"10.2310/obg.19011","DOIUrl":"https://doi.org/10.2310/obg.19011","url":null,"abstract":"Abnormal uterine bleeding (AUB) is a common presentation that can occur in all age groups. AUB is an umbrella term for any uterine bleeding that occurs outside a woman’s normal pattern in volume, regularity, and/or timing. AUB is described by using frequency, regularity, duration, and volume or by using PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and premalignant conditions; Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified). Workup for AUB comprises a history (with a detailed menstrual history), physical examination (including a pelvic and bimanual examination), lab tests, and imaging (primarily transvaginal ultrasonography). For treatment, medical therapies should be considered before surgical therapies, especially when fertility is desired. The decisions for treatment are based on etiology, fertility concerns, contraindications, or patient preference. Of the medical therapies, there are hormonal and nonhormonal therapies. The most common treatments for AUB are levonorgestrel intrauterine device, tranexamic acid, oral contraceptives, and nonsteroidal anti-inflammatory drugs. The most common surgical treatments are myomectomy, endometrial ablation, uterine artery embolization, and hysterectomy.\u0000This review contains 7 figures, 11 tables and 49 references\u0000Key words: abnormal uterine bleeding, adenomyosis, contraceptives, endometrial, fibroids, hysterectomy, menorrhagia","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121629383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethical and Social Issues in Medicine","authors":"R. Loewy, E. Loewy, Faith T. Fitzgerald","doi":"10.2310/obg.1222","DOIUrl":"https://doi.org/10.2310/obg.1222","url":null,"abstract":"So rapidly has the field of health care ethics continued to grow that, when recently “googled,” the term produced 28.2 million hits. The challenge is to address the ethical and social issues in medicine in this very limited article space. It remains an impossible task to present more than a superficial discussion of these complex issues and the complicated cases in which they are to be found. Like good medicine, good ethics cannot be practiced by algorithm. The authors have opted to provide an operational guide to help clinicians sort through the ethical and social quandaries they must face on a daily basis. To that end, the authors have chosen to divide this chapter into the following sections: 1. A brief description of the biopsychosocial nature of ethics and how it differs from personal morality 2. A method for identifying and dealing with ethical issues 3. A discussion of the role of bioethicists and ethics committees 4. The professional fiduciary role of clinicians 5. Listings of some of the common key bioethical and legal terms (online access only) 6. A very brief discussion of the terms cited in the above listings (online access only)\u0000This reviews contains 4 tables, 8 references, 1 appendix, and 20 additional readings.\u0000Keywords: Ethical, social, right, wrong, good, bad, obligation, moral authority, critically reflective, and multiperspectival activity, Curiosity, Honesty, Patience, Open-mindedness","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117245144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sexually Transmitted Infections","authors":"Huma Farid, Elinor Brown, T. Golen","doi":"10.2310/OBG.19009","DOIUrl":"https://doi.org/10.2310/OBG.19009","url":null,"abstract":"Sexually transmitted infections (STI’s) are relatively common. Their presentations range from symptom-free to highly painful, debilitating and life-threatening. The approach to each type of infection varies, and depends on the ability to screen, the availability and effectiveness of treatment, and the likelihood of long-term sequelae. For many infections, prophylaxis is possible; other infections are more challenging to prevent. Unless sexual partners are also treated, re-infection is a concern, as is the further spread of disease to subsequent sexual contacts. Some infections, once effectively treated, lead to an asymptomatic carrier state that may or may not re-emerge as an active problem and/or cause sexual contacts to become ill. \u0000This review contains 10 tables, and 44 references.\u0000Key Words: sexually transmitted infections, chlamydia, gonorrhea, syphilis, HIV, herpes simplex, granuloma inguinale, lymphogranuloma venereum, chancroid, trichomoniasis","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121247149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abnormal Pap Smear","authors":"Huma Farid","doi":"10.2310/OBG.19006","DOIUrl":"https://doi.org/10.2310/OBG.19006","url":null,"abstract":"Since the Papanicolaou (Pap) smear became implemented as a screening tool for cervical cancer, the mortality from cervical cancer has sharply declined in the United States. The discovery of the human papillomavirus (HPV) as the causative agent in the progression from dysplasia of the cervix to cervical cancer has changed the types of screening offered to women and the management of abnormal Pap smears. The management of abnormal Pap smears has changed depending on the age of the woman, with women under the age of 24 years being managed more conservatively given the low rates of cervical cancer in this age group and the high rates of regression of HPV and cytologic abnormalities. Colposcopy remains the first line in evaluation of an abnormal Pap smear, with excisional treatment reserved for high-grade dysplasias with a high risk of progression to cervical cancer. Treatment for cervical dysplasia is highly effective, but even after treatment, there is an increased risk of recurrence or progression to cervical cancer for up to 25 years, and these women should be followed closely. \u0000This review contains 18 figures, 3 tables, and 43 references.\u0000Key words: cervical cancer screening, high-grade cervical dysplasia, human papillomavirus, low-grade cervical dysplasia, management of abnormal Pap smears, Pap smear, recurrence of cervical dysplasia, treatment of dysplasia","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115387604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Common Maternal Genetic Syndromes III: Ehlers-Danlos Syndrome","authors":"A. Vidaeff","doi":"10.2310/OBG.19144","DOIUrl":"https://doi.org/10.2310/OBG.19144","url":null,"abstract":"The purpose of this work is to improve the basis upon which advice on pregnancy is given to women with Ehlers-Danlos syndrome (EDS) and to address issues of obstetric management by drawing upon the accumulated world experience. Although, overall, pregnancy in EDS is well tolerated, with good outcomes, the rate of maternal and perinatal complications is higher and every pregnancy in these women remains a high-risk pregnancy. The obstetrical outcomes are influenced by the type of EDS and the specific underlying abnormalities. The older numeric classification of EDS has been largely abandoned and it was replaced by the 2017 descriptive international classification. Based on this new classification, we are briefly describing the most common EDS types and consider the management implications imposed by pregnancy and delivery.\u0000 \u0000This review contains 2 figures, 1 table, and 36 references.\u0000Keywords: Ehlers-Danlos syndrome, EDS types, pregnancy, delivery, EDS classification, counseling, genetic screening, neonatal outcomes ","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114760930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Invasive Prenatal Diagnosis","authors":"Kimberly Zayhowski","doi":"10.2310/OBG.19130","DOIUrl":"https://doi.org/10.2310/OBG.19130","url":null,"abstract":"Despite recent advances in genetic technologies that are making invasive prenatal diagnosis less common, amniocentesis and chorionic villus sampling (CVS) remain an integral part of prenatal care. A multitude of tests, including a variety of genetic tests, can be performed using samples collected from either procedure. Although invasive testing has limitations, many genetic conditions can only be diagnosed through invasive techniques during pregnancy. Invasive testing continues to assist patients and providers in making informed decisions regarding the care of pregnancies. This review details amniocentesis and chorionic villus sampling with a focus on genetic testing, describing why the tests are performed, the way in which they are performed, and the associated limitations and complications of the procedures. \u0000This review 5 figures, 3 tables, and 26 references.\u0000Keywords: prenatal diagnosis, amniocentesis, chorionic villus sampling, genetic testing, genetic counseling, invasive prenatal testing, pregnancy, aneuploidy","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133868907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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