Clinical obstetrics and gynecology最新文献

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.

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.

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.

Pain that occurs during sexual activity is highly prevalent during a woman's lifetime, affecting ∼15% of women. The etiology of dyspareunia is multifactorial. Therefore, treatment must be individualized. This paper reviews the evaluation and treatment of the several common causes of dyspareunia and/or pelvic pain, including hormonally associated vestibulodynia, inflammation-associated vestibulodynia, neuroproliferative vestibulodynia, overactive pelvic floor muscle dysfunction, vulvar dysesthesia, persistent genital arousal disorder, and painful bladder syndrome.

This comprehensive review examines the effects of various infections on pregnancy, focusing on maternal symptoms, fetal outcomes, diagnostic methods, and placental pathology. The paper covers bacterial, viral, and parasitic infections, their mechanisms of transmission, clinical presentations, and histopathologic findings in the placenta. It emphasizes the importance of early detection and intervention, highlighting the challenges in diagnosis due to often asymptomatic presentations. The review also discusses the placenta's role as a protective barrier and its immune defense mechanisms against pathogens. Overall, this paper serves as a comprehensive resource for understanding the complex interplay between maternal infections, placental pathology, and fetal outcomes.

The clinical implications of placental chromosomal mosaicism can be challenging for patients and health care providers. Key considerations include the specific characteristics of the chromosomal abnormality (such as size, gene content, and copy number), the timing of the mosaicism's onset during embryogenesis or fetal development, the types of tissues involved, and the level of mosaicism (the ratio of normal to abnormal cells within those tissues). Genetic counseling can help inform patients about the chances of having a live-born child with a chromosomal abnormality. Each case requires individual assessment to provide accurate guidance. This chapter will explore the clinical implications of detecting mosaicism at 3 critical diagnostic stages: (1) chorionic villus sampling (CVS); (2) amniocentesis; and (3) cell-free DNA (cfDNA) testing.

Ischemic placental disease (IPD) is a constellation of obstetrical complications that include preeclampsia, placental abruption, and fetal growth restriction and affects 12% to 15% of pregnancies. The unifying pathophysiological mechanism that precedes all 3 complications is uteroplacental ischemia as a consequence of inadequate (or failure of) physiological transformation of the maternal uterine spiral arteries, endothelial cell dysfunction, and increased oxidative stress. This review summarizes the IPD literature, focusing on the epidemiology and risk factors, the effects of IPD on short and long-term maternal complications, and the association of IPD with perinatal, childhood, and long-term complications in offspring.

Testosterone levels vary throughout a woman's reproductive life, reaching their lowest level following menopause, and their nadir at about age 60, when they experience higher levels of sexual dysfunction. Testosterone improved the frequency of sexually satisfying events, desire, arousal, and orgasm in several randomized, controlled studies of surgically and naturally postmenopausal women. Available evidence from large cohort and registry studies does not show potentially concerning cardiovascular or breast safety signals with physiological levels of testosterone. Although no female testosterone products are currently approved in most of the world, one-tenth of the male dose can enhance female sexual function.