Clinical obstetrics and gynecology最新文献

Sexual health is multidimensional across the lifespan. At midlife, women may face challenges to sexuality, often requiring intervention. Menopause-related and age-related hormonal changes intermingle with common medical conditions and contribute to biological substrates less favorable to a healthy sexual response. Psychological, sociocultural, and relational factors modulate the impact of such changes positively or negatively, contributing to adaptation or manifestation of sexually related distress. A comprehensive diagnostic approach and multidimensional management are needed to address sexual symptoms due to both menopause and aging, individualizing non-pharmacological and pharmacological evidence-based treatment options according to personal goals and expectations in the woman/couple.

Placenta previa is an important and potentially life-threatening cause of bleeding. Historically, it was a major contributor to maternal mortality until advancements in obstetric care, including prenatal ultrasound, cesarean delivery, and transfusion medicine, drastically improved outcomes. Today, placenta previa is typically identified during routine second-trimester ultrasound, with the overwhelming majority of cases resolving before term. Key risk factors include prior cesarean delivery, advanced maternal age, and smoking. When placenta previa is diagnosed, it is essential to assess for associated conditions like placenta accreta and vasa previa. A planned cesarean delivery is recommended in cases that persist into the late third trimester.

The pelvic floor muscles, integral to urinary, bowel, and sexual function, can cause various symptoms when impaired, including pelvic pain, bowel and bladder dysfunction, incontinence, pelvic organ prolapse, and sexual dysfunction. This chapter explores pelvic floor anatomy, symptoms, and associated diagnoses. It provides screening tools for OBGYNs to use in practice, language to help address patient fears around sexual dysfunction, and emphasizes the role of pelvic floor physical and occupational therapy in treating these conditions.

Vasa previa is an abnormality of the umbilical cord and fetal membranes that affects ∼1 in 1300 pregnancies. The diagnosis is made by visualization of velamentous fetal vessels coursing within the membranes over the cervix unprotected by Wharton jelly or placenta. When it is not diagnosed prenatally, it is associated with a high risk of fetal death. Prenatal diagnosis of vasa previa using ultrasound, followed by close surveillance, and appropriately timed late preterm delivery by cesarean is associated with intact survival in >95% of cases. In this review, we review epidemiology, risk factors, diagnosis, and management of patients with vasa previa.

Placental imaging is crucial in prenatal care, offering insights into both normal and abnormal pregnancies. Traditional methods like grayscale ultrasound and magnetic resonance imaging evaluate placental anatomy, whereas Doppler ultrasound is used for functional assessment. Recent advancements include functional magnetic resonance imaging and advanced Doppler software for demonstrating placental density and visualizing spiral arteries. B-flow and spatio-temporal image correlation are pivotal, sensitive tools for quantifying spiral artery distensibility and volume flow in early pregnancy. These techniques enhance our understanding of placental vascular architecture and promise early diagnosis and intervention for pregnancies at risk. This paper emphasizes the importance of advanced imaging in prenatal care.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is a distressing condition characterized by persistent or recurrent, unwanted, or intrusive sensations of genital arousal that occur in the absence of subjective feelings of sexual desire that persist for at least 3 months. Despite its negative psychosocial impact, including high levels of suicidal ideation, it is not well known by most health care providers and can easily be misdiagnosed or remain undiagnosed. This paper describes a detailed biopsychosocial regional algorithm for the assessment and management of PGAD/GPD and draws attention to the need for multidisciplinary approaches to its effective management.

This paper provides a summary of the biopsychosocial approach to the identification of female sexual dysfunction, with a particular focus on psychological, interpersonal, and sociocultural components. A summary of psychotherapeutic approaches to the management of female sexual dysfunction, for cases warranting a specialist referral, is provided. Approaches including sensate focus sex therapy, cognitive behavioral therapy, mindfulness-based approaches, and systematic desensitization are summarized. This information may support obstetric and gynecologic health care professionals in engaging in interdisciplinary care and in providing an informative and warm referral to patients who would benefit from psychotherapeutic approaches.

This review evaluates pharmacologic treatments for female sexual dysfunction (FSD), focusing on hypoactive sexual desire disorder (HSDD). We provide clinically relevant applications for Food and Drug Administration (FDA)-approved medications (flibanserin and bremelanotide) and investigational therapies (Lorexys and testosterone combinations). Detailed study outcomes, safety profiles, and clinical strategies guide clinicians in appropriate diagnosis, patient selection, expectation setting, side effect management, and patient education, improving treatment outcomes and patient satisfaction.