2. Patient Presentations Related to Human Development, Reproduction, and Sexuality

Patient presentations span all relevant age categories, special populations, and varied clinical settings.

The guide to clinical presentations in this category may include, but is not limited to, the following ways in which patients present for osteopathic medical care:

ABO incompatibility • abortion – threatened, inevitable, missed, medical and surgical (therapeutic); elective; spontaneous (miscarriage); complete, incomplete • abruptio placentae • ambiguous genitalia • androgen insensitivity • antepartum care • artificial nutrition and hydration • bacterial infections (e.g., streptococcal, gonococcal) in obstetrics • biophysical profile • birth trauma • bleeding in pregnancy • bloody show • caloric consumption, adequate or inadequate • cerebral palsy • cervical insufficiency • children with special needs • chromosomal abnormalities • congenital/genetic anomalies (e.g., Down syndrome, cystic fibrosis, craniosynostosis), malformations, innate immune disorders, cellular and antibody deficiencies • contraceptives – oral, injectable, implantable; vaginal rings and other barrier methods; abstinence and fertility awareness methods; surgical methods (e.g., tubal ligation, vasectomy) • developmental milestones, physiologic, of normal infant, child, and adolescent and healthy aging of adult and geriatric patients • developmental milestones, standard, including social/emotional, language/communication, cognitive, fine/gross motor development • eclampsia • ectopic pregnancy • embryo harvesting, storage, and implantation • endometriosis • failure to meet developmental milestones (e.g., isolated domain delays, global domain delays) • failure to thrive, adult or child • fetal and neonatal infections, bacterial or viral (e.g., antepartum, intrapartum, postpartum) • fetal status indicators, reassuring and non-reassuring (e.g., fetal heart tone variability, decelerations) • gestational trophoblastic disease • glycogen storage disorders • HELLP syndrome • hydrocele • hypogonadism • hypotonic infant • in vitro fertilization • induction of labor • infertility, male or female (includes disorders of sperm production, motility, and transport) • initial neonatal assessment • intellectual disability • jaundice/hyperbilirubinemia in the newborn • labor and delivery • lactation • language and social impairment (e.g., autism spectrum disorder and related entities) • large for gestational age • learning difficulties (e.g., dyslexia, attention deficit hyperactivity disorder) • maternal substance abuse – maternal and neonatal complications • menarche • menopause • metabolic disturbances (e.g., hypoglycemia, hypothyroidism) • multiple gestation • neonatal sepsis • oligo/polyhydramnios • pelvic adhesions • physiologic changes of pregnancy • placenta previa, accreta, marginatum • placental insufficiency • polycystic ovary syndrome • postpartum care • postpartum hemorrhage • precocious puberty • preconception counseling • preeclampsia • pregnancy complications (e.g., pyelonephritis, cholecystitis, appendicitis) • pregnancy loss • premature newborn • premature rupture of membranes • premature sexual maturation • prenatal counseling • preterm infant complications (e.g., patent ductus arteriosus, necrotizing enterocolitis, retinopathy of prematurity) • preterm labor • primary ovarian failure • protein-energy malnutrition • psychosocial or medical illnesses or situations (e.g., neglect) • recurrent pregnancy loss • respiratory distress of the newborn (e.g., meconium aspiration, transient tachypnea) • Rh isoimmunization/incompatibility • rupture of membranes • sexual development • sexual dysfunction, male or female (e.g., vaginismus, vaginal dryness, erectile dysfunction, priapism, dyspareunia), reduced or absent desire, arousal, or orgasm • small for gestational age, including intrauterine fetal growth restriction or discrepancies • spermatocele • testicular cancer • uterine rupture • viral infections (e.g., TORCH infections) • virilization

CONSTITUTIONAL SIGNS AND SYMPTOMS
fatigue • fever • generalized weakness • involuntary weight loss • malaise • night sweats • pallor

PHYSICAL EXAM FINDINGS
bimanual ovarian and uterine palpation • external genitalia inspection and palpation • gynecologic speculum exam • Leopold maneuvers • manual cervical checks in labor • symphysis fundal heights • Tanner stages of sexual maturation

LABORATORY TEST FINDINGS AND DIAGNOSTIC IMAGING
β-HCG levels • bilirubin levels, total serum and conjugated • bone age measurements • bone density studies • cervical culture and sensitivity • CT scanning • DHEA-S levels • genetic screening in pregnancy • gestational diabetes screening • Gram staining • hemoglobin electrophoresis • magnetic resonance imaging • newborn blood-screening tests • Pap smear • prenatal lab panels • radiography • semen analysis • serum testosterone, estrogen, and FSH levels • ultrasonography, including obstetric ultrasounds