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Heavy menstrual bleeding

11.1 Introduction Heavy menstrual bleeding (HMB) is a common condition that affects 20%–30% of women during their reproductive age and has a major impact on women’s quality of life. The International Federation of Gynaecology and Obstetrics (FIGO) has defined HMB as “the women’s perception of increased menstrual volume regardless of regularity, frequency or duration.” FIGO also define HMB as part of broader terminology of abnormal uterine…

Medical and surgical interventions to improve fertility outcomes

10.1 Introduction 1. The prevalence of obesity is increasing worldwide with more than 600 million obese adults, including 15% of women, in 2014. 2. Being overweight in early adulthood increases the risk of menstrual irregularities, ovulatory dysfunction, and consequently subfertility. 3. An increasing number of men and women with high body mass index (BMI) are being referred for the evaluation and treatment of subfertility across the…

Obesity and assisted conceptionion

9.1 Introduction The World Health Organization defines obesity as abnormal or excessive fat accumulation that impairs health. Obesity is most commonly defined using body mass index (BMI). The percentage of obese women (BMI ≥30) in the United Kingdom has increased from 16.4% in 1993 to 23.8% in 2004. In the reproductive age group, a third of the women are overweight (BMI 25–30) and one in five…

Obesity—recurrent miscarriage

8.1 Introduction Recurrent miscarriage (RM) is defined as loss of three or more consecutive pregnancies prior to 20 weeks of gestation, though some authors describe RM as two or more consecutive pregnancy losses. The incidence of RM has been reported to be around 0.5%–2.3% and is rising in relation to the prevalence of obesity. It has been estimated that 1%–2% of second-trimester pregnancies miscarry before 24…

Obesity: male and female infertility

7.1 Introduction Obesity has become a global epidemic, affecting more than 650 million adults worldwide. The prevalence of obesity has consistently increased to the point where more than 35% of adults are now considered to be obese. Women are generally more prone to obesity than men possibly because of their lower basal metabolic rate. The effect of obesity on reproductive function reflects through complex endocrinological changes…

Obesity and sexual health

1. Sexual health is an important part of overall health, well-being, and quality of life. 2. The association between obesity and physical illness is well established. 3. There is a growing recognition of the negative impact that obesity can have on sexual health. 4. This may be mediated directly through the physical and psychosocial effects or indirectly through concurrent comorbidities. 5. It can affect sexual behaviour,…

Contraception after bariatric surgery

5.1 Introduction Bariatric surgery is the most effective treatment for morbid obesity. National Institute of Health has laid out criteria for a group of patients who should be considered suitable for bariatric surgery: 1. Body mass index (BMI)>40. 2. BMI of 30–40 plus one of the following obesity-related comorbidities: severe diabetes mellitus, Pickwickian syndrome, obesity-related cardiomyopathy, severe sleep apnoea, or osteoarthritis interfering with lifestyle. Bariatric surgeries…

Contraception for obese and super obese women

1. Obesity continues to be a major public health concern across the globe. 2. The prevalence of obesity has doubled over the past 30 years with 15% of women worldwide classified as obese as of 2014. 3. It is reported that obese women have less contraceptive usage, more contraceptive failure, and lower intake of preconceptional folic acid, which can greatly compromise prepregnancy and pregnancy care. 4.…

Hirsutism

Hirsutism affects a significant proportion of women of reproductive age. The incidence of hirsutism is highly variable depending on location and ethnicity, being higher in those of African or Mediterranean origin. It affects self-confidence, image and the quality of life of the woman. Hirsutism is defined when there is an excessive amount of terminal hair growth in androgen-sensitive areas in women. Excessive hair growth occurs as…

Polycystic ovary syndrome

2.1 Introduction Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. According to the National Institute of Health (NIH) criteria, the prevalence of PCOS ranges between 6% and 10% and with utilisation of the ESHRE/ASRM consensus criteria, it is as high as 15%. 2.1.1 Clinical presentation PCOS may appear for the first time during adolescence. The symptoms usually…

Obesity, the onset of adolescence and menstrual disorders

1. Obesity among children, adolescents, and adults is set to be one of the most important public health concerns of the 21st century. 2. Over the last three decades, the incidence of obesity in childhood and adolescence has been a growing epidemic, with a rise by more than a half of overweight and a doubling of obesity. 3. All around the world, 1 in 10 young…

A Life-Course Perspective for Women’s Health Care: Safe, Ethical, Value-Based Practice with a Focus on Prevention

Clinical Keys for this Chapter ▪ Clinical practice in obstetrics and gynecology, based upon the principles of safe, ethical and value-based care, is facilitated by viewing wellness and sickness in the context of a life-course perspective. Effective clinical care of mother and child must begin early, even before conception, and continue throughout life. ▪ Adaptive developmental plasticity and epigenetic modification of genes during and after pregnancy…

Mental Health and Behavioral Disorders in Pregnancy

Open full size image Key Abbreviations American Academy of Neurology AAN American Academy of Pediatrics AAP American Psychiatric Association APA Antiepileptic drugs AED Anorexia nervosa AN Attention-deficit/hyperactivity disorder ADHD Bipolar disorder BD Binge eating disorder BED Body mass index BMI Bulimia nervosa BN Cognitive behavioral therapy CBT Carbamazepine CBZ Centers for Disease Control and Prevention CDC Central nervous system CNS Concentration to dose (ratio) C/D Confidence…

Maternal and Perinatal Infection in Pregnancy: Bacterial

Open full size image Key Abbreviations Acute respiratory distress syndrome ARDS Body mass index BMI Centers for Disease Control and Prevention CDC Central nervous system CNS Computed tomography CT Fluorescent treponemal antibody absorption FTA-ABS Group A streptococcus GAS Group B streptococcus GBS Immunoglobulin M IgM Intramuscular IM Intravenous IV Magnetic resonance imaging MRI Methicillin-resistant Staphylococcus aureus MRSA Nucleic acid amplification tests NAATs Polymerase chain reaction PCR…

Maternal and Perinatal Infection in Pregnancy: Viral

Open full size image Key Abbreviations Abacavir ABC Acquired immunodeficiency syndrome AIDS American College of Obstetricians and Gynecologists ACOG Antiretroviral ARV Antiretroviral therapy ART CC-chemokine receptor type 5 CCR5 Centers for Disease Control and Prevention CDC Central nervous system CNS Congenital rubella syndrome CRS Congenital varicella syndrome CVS Congenital Zika syndrome CZS C-X-C chemokine receptor type 4 CXCR4 Cytomegalovirus CMV Deoxyribonucleic acid DNA Direct acting antivirals…

Skin Disease and Pregnancy

Open full size image Key Abbreviations Atopic dermatitis AD Atopic eruption of pregnancy AEP Estrogen receptor ER Intrahepatic cholestasis of pregnancy ICP Malignant melanoma MM Pemphigoid gestationis PG Polymorphic eruption of pregnancy PEP Prurigo of pregnancy PP Pruritic folliculitis of pregnancy PFP Psoralen with ultraviolet light A PUVA Ultraviolet light B UVB This chapter reviews the physiologic skin changes induced by pregnancy, along with preexisting skin…

Malignant Diseases and Pregnancy

Open full size image Key Abbreviations α-Fetoprotein AFP β–Human chorionic gonadotropin β-hCG Carcinoembryonic antigen CEA Complete hydatidiform mole CHM Computed tomography CT Fine-needle aspiration FNA Food and Drug Administration FDA Gestational trophoblastic disease GTD Gray Gy Hodgkin lymphoma HL Magnetic resonance imaging MRI Non-Hodgkin lymphoma NHL Partial hydatidiform mole PHM The diagnosis of cancer for anyone is understandably frightening. The juxtaposition of a new life and…