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Marcia Haskell Group

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Clinical Gynecologic Speroff Pdf 20

Polycystic ovary syndrome (PCOS) is the most common endocrine, metabolic, and multi-causal disorder in the reproductive period with a possible genetic origin. Women with PCOS are characterized by oligo-ovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries. Women with PCOS have an increased number of antral follicles. Anti-Mullerian hormone (AMH), a dimeric glycoprotein produced from the granulosa cells of the pre-antral and antral follicles, is elevated in PCOS. AMH has been implicated in two stages of follicle dysfunction that lead to the development of PCOS. The level of AMH decreases following ovarian drilling in patients with PCOS. The present study compared the level of AMH before and after Laparoscopic ovarian drilling (LOD) in patients with PCOS and its effect on fertility.

Clinical Gynecologic Speroff Pdf 20

People with PCOS have higher levels of testosterone, insulin, triglycerides, cholesterol, and lutein than healthy people. They also have lower levels of sex hormone-binding globulin (SHBG) and follicular growth hormone (FSH) than healthy people [7, 8]. Dyslipidemias are also a common finding in PCOS. Other findings in women with PCOS include an increase in the prevalence of hypertension, a higher incidence of atherosclerosis and cardiovascular disease, and an increased risk of myocardial infarction (about 7 times higher than the healthy people) [5]. The clinical association between hyperinsulinemia and anovulation associated with hyperandrogenism is well known worldwide and among all racial groups [5]. Due to the physical and mental problems following PCOS in women, this disease significantly reduces the quality of life [7]. These patients are at risk for various psychological disorders due to metabolic disorders and especially disorders in the level of sex hormones, especially testosterone [8,9,10].

MJM evaluated the patients clinically and prepared the first and draft revised the paper. HS, SS, and NA prepared the first draft and revised the paper. All authors read and approved the final manuscript.

Purpose: Females with 17α-hydroxylase/17,20-desmolase deficiency normally present with amenorrhea, sexual infantilism, hypertension, and hypokalemia. We report on a new clinical presentation of this combined enzymatic defect.

Results: The clinical characteristics and endocrine testing results support the diagnosis of a partial deficiency in 17α-hydroxylase/17,20-desmolase activities, shared by the adrenal gland and the ovaries.

Since 1987, CDC has monitored abortion-related deaths through PMSS, which includes data from all 50 states, the District of Columbia, and New York City (33). Sources of data to identify abortion-related deaths have included state vital records; media reports, including computerized searches of full-text newspaper and other print media databases; and individual case reports by public health agencies, including maternal mortality review committees, health care providers and provider organizations, private citizens, and citizen groups. For each death that is possibly related to abortion, CDC requests clinical records and autopsy reports. Two medical epidemiologists independently review these reports to determine the cause of death and whether the death was abortion related. Discrepancies are discussed and resolved by consensus. Each death is categorized by abortion type as legal induced, illegal induced, spontaneous, or unknown type.

Second, routine abortion surveillance can be used to assess changes in clinical practice patterns over time. Information in this report on the number of abortions performed through different methods (e.g., medical or surgical) and at different gestational ages provides the denominator data that are necessary for analyses of the relative safety of abortion practices (102,103). Finally, information on the number of pregnancies ending in abortion is used in conjunction with data on births and fetal losses to estimate the number of pregnancies in the United States and determine rates for various outcomes of public health importance (12).

HMB could be treated with both medical and surgical interventions and both methods are safe, acceptable and effective. Although hysterectomy is a definitive treatment for heavy menstrual bleeding with or without other gynecologic conditions such as fibroids, adenomyosis or endometriosis. a medical treatment is the preferred primary intervention in most circumstances as surgery is associated with higher although minimal risks (approximately 1%) [14] of internal organ injury (bowel, bladder and ureteric), hemorrhage, infection and mortality [15]. The treatment goal is to control the current episode of heavy bleeding and to reduce menstrual blood loss in subsequent cycles. The American College of Obstetricians and Gynecologists suggested that the selection of treatment for each woman depends on clinical stability, overall acuity, suspected etiology of bleeding, desired for future fertility and underlying medical problems [16].

Polyps, adenomyosis and leiomyoma are common structural abnormalities of the uterus, which are associated with abnormal bleeding. Despite the presence of these clinical findings, a thorough history and physical examination are needed to determine whether they are the cause of the abnormal bleeding. Location and size of uterine myoma (fibroids) are associated with varying amounts of menstrual blood loss. Myomas that increase the surface area of the endometrium such as sub mucosal myomas are more likely to be associated with bleeding abnormalities than myomas at other locations [18]. Intramural and cervical myomas are also associated with bleeding as they could distort the shape of endometrial surface, however subserosal myoma is less likely to be associated with abnormal bleeding. The mechanism(s) whereby myomas increase menstrual blood loss is unclear, but abnormal bleeding due to leiomyomas may be related to uterine vasculature abnormalities or impaired or dysregulated endometrial hemostasis [19].

Gonadotropin-releasing hormone (GnRH) agonists and antagonists are synthetic decapeptides that bind to the GnRH receptor resulting in a decreased pituitary secretion of follicular stimulating hormone (FSH) and luteinizing hormone (LH). GnRH agonists initially cause a flare response, a rapid increase in FSH and LH, followed by desensitization of the receptor resulting in a hypogonadotropic hypogonadal state or pseudo menopause with low levels of FSH and LH. GnRH antagonist do not elicit a flare but immediately reduce FSH and LH secretion. Gonadotropin releasing hormone agonists suppress follicle development decrease ovarian hormone secretion and result in endometrial atrophy and amenorrhea [56]. Non peptide orally active Gonadotropin releasing hormone antagonists can also reduce heavy menstrual bleeding associated with uterine myomas but are not yet regulatory agency approved for clinical use [57].

Although heavy menstrual bleeding is a common gynecological problem, there is a challenge in diagnosis and treatment as the condition cannot not be explained by a single hemostatic pathway. Several medical therapeutic options are available but each involves a different biologic pathway. Surgical intervention is always available but ablation of the endometrium or hysterectomy results in involuntary infertility and is associated with other morbidities. Thorough understanding of the clinical findings and the relationship to the bleeding pattern involving should lead to a tailored treatment for each individual patient.

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