Obstetrics and gynecology clinics of North America
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Obstet. Gynecol. Clin. North Am. · Sep 2009
ReviewClinical approach and office evaluation of the patient with pelvic floor dysfunction.
Pelvic floor disorders are common health issues for women and have a great impact on quality of life. These disorders can present with a wide spectrum of symptoms and anatomic defects. ⋯ The goal of treatment is to provide as much symptom relief as possible. After education and counseling, patients may be candidates for non-surgical or surgical treatment, and expectant management.
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The pelvic floor represents the neuromuscular unit that provides support and functional control for the pelvic viscera. Its integrity, both anatomic and functional, is the key in some of the basic functions of life: storage of urine and feces, evacuation of urine and feces, support of pelvic organs, and sexual function. When this integrity is compromised, the results lead to many of the problems seen by clinicians. ⋯ Pelvic floor dysfunction can also involve the development of hypertonic, dysfunctional muscles. This article discusses the pathophysiology of hypertonic disorders that often result in elimination problems, chronic pelvic pain, and bladder disorders that include bladder pain syndromes, retention, and incontinence. The hypertonic disorders are very common and are often not considered in the evaluation and management of patients with these problems.
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This article summarizes and critically evaluates the scientific literature for the annual and lifetime medical care costs of obesity in women in the United States. Studies involving actual and projected costs are reviewed. Studies were favored that included large, nationally representative samples; accounted for the influence of potential confounding factors; and adjusted for decreased survival in obese women when comparing costs with women of normal weight. Despite a wide variety of methodology in model cost estimation and projection in the studies published, the evidence suggests significant costs attributable to overweight and obesity in women that vary throughout the lifespan and by specific racial and obesity categories.
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Polycystic ovary syndrome (PCOS) is now recognized as a heterogeneous disorder that results in overproduction of androgens, primarily from the ovary, leading to anovulation and hirsutism and is associated with insulin resistance. Long-term sequellae of PCOS include higher risk for diabetes, obesity, metabolic syndrome, endometrial hyperplasia, and anovulatory infertility. Symptoms in the adolescent include oligomenorrhea, hirsutism, acne, and weight gain. ⋯ Treatment should be instituted early to decrease symptoms and long term sequellae of PCOS. Weight loss, oral contraceptives, and antiandrogens are effective in treating the symptoms of this disorder. Insulin-sensitizing medications have been shown to be effective but should be used with caution until larger randomized trials have shown short- and long term benefits and efficacy over traditional therapies in the adolescent population.
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Obstet. Gynecol. Clin. North Am. · Sep 2008
ReviewPrenatal diagnosis and genetic screening--integration into prenatal care.
In the last 3 decades, perinatal medicine has made tremendous advances in scientific knowledge and in the successful application of this knowledge toward understanding the fetal aspects of pregnancy. Evaluation of the health of the fetus and screening for birth defects has become an important part of prenatal care. This article provides an overview of birth defects and the various screening methods for diagnosing birth defects before birth. It also discusses the role of preconception genetic screening.