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Hunter L.A.,Brown University | Hunter L.A.,Infants Hospital | Gibbins K.J.,Brown University
Journal of Midwifery and Women's Health | Year: 2011

First used anecdotally for the control of eclamptic seizures in the early 1900s, magnesium sulfate remains 1 of the most commonly used medications in obstetric practice today. Over the past 95 years, there have been countless research studies investigating the efficacy of magnesium sulfate for the management of eclampsia, preeclampsia, preterm labor, and most recently for prevention of cerebral palsy. The majority of this evidence undeniably supports the use of magnesium sulfate as the drug of choice for the prevention and treatment of eclampsia when evidence of severe disease is present. On the other hand, studies have not shown magnesium sulfate to be comparably more effective than other tocolytics for treating preterm labor, nor is there agreement on whether the evidence supports its use as a neuroprotective agent for prevention of cerebral palsy. The exact mechanism of action of magnesium sulfate remains largely hypothetical, and parenteral use has the potential to cause significant morbidity in high doses. This article reviews magnesium sulfate's remarkable history in obstetric practice and includes a summary of the evidence related to each of the controversies. An initial review of the physiology of magnesium sulfate is essential to understanding pharmacodynamic actions, dosing guidelines, and safety requirements. © 2011 by the American College of Nurse-Midwives.

Pilzek A.L.,Brown University | Raker C.A.,Infants Hospital | Sung V.W.,Brown University
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2014

Introduction and hypothesis: Our goal was to describe patients' personal treatment goals before pelvic floor dysfunction (PFD) surgery and goals achieved and not achieved 12 months after surgery, and to evaluate the association between postoperative symptoms and successful goal achievement. Materials and methods: We performed a secondary analysis using a de-identified database from a randomized trial comparing native tissue vs. graft-augmented rectocele repair. In their own words, women listed their top four treatment goals and 12 months after surgery whether those goals were or were not achieved. We categorized goals into symptom improvement (defecatory, bulge, incontinence, pain/discomfort) and functioning (physical, social, emotional, sexual). Women completed symptom questionnaires pre- and postoperatively. Goals were described using simple statistics. The association between defecatory, bulge, and incontinence symptoms and goal achievement was described using the chi-square test. Results: Of 160 participants in the database, 125 (78 %) met inclusion criteria. The most common preoperative goals were improvement in bulge (26.7 %), defecation (23.9 %), urinary incontinence (18.1 %), and pain/discomfort (6.2 %). Functioning goal categories included: sexual (7 %), emotional (7 %), physical (6.2 %), and social function (3.3 %). Postoperatively, goal categories in which improvement was achieved were urinary continence (70.5 %), sexual function (58.8 %), bulge reduction (56.9 %), defecation (51.7 %), physical (33.3 %), emotional (29.4 %), and social functioning (25 %). Of the women reporting postoperative defecatory or incontinence symptoms, half reported successful improvement in both goals. Conclusions: Women predominantly reported symptom-related goals, and those goals are most frequently achieved postoperatively. Of women who reported defecatory and incontinence symptoms postoperatively, many still reported successful goal achievement in those areas. © 2013 The International Urogynecological Association.

Gage J.C.,U.S. National Institutes of Health | Ajenifuja K.O.,Obafemi Awolowo University | Wentzensen N.A.,U.S. National Institutes of Health | Adepiti A.C.,Obafemi Awolowo University | And 8 more authors.
International Journal of Cancer | Year: 2012

Cervical screening for carcinogenic human papillomavirus (HPV) infection is being considered for low-income countries. Effectiveness requires targeted screening in older women in whom prevalent infections are more likely to be persistent and predictive of precancer. Some studies in West Africa have found unusually high HPV prevalences across all adult ages, which may reduce the positive predictive value (PPV) of HPV-based screening, if positivity in older women does not sufficiently predict elevated risk. We conducted a population-based study in rural Nigeria to identify HPV prevalence and associated cervical abnormalities. Using stratified random sampling, we enrolled women age 15+. Nonvirgins had a cervical exam including liquid-based cytology and PCR HPV DNA testing from residual cytology specimens. Two-thirds of invited women participated, and 14.7% had detectable carcinogenic HPV, a proportion that did not decline with age (p-trend = 0.36) and showed slight peaks in the 15-29 and 60-69 age groups. Among women of the age typically considered for screen-and-treat programs (30-49 years), 12.8% were HPV positive, and the PPV for high-grade or worse cytology was 16.4%. Comparatively, women age < 30 were more likely to be HPV positive (18.9%, p = 0.03) with a lower PPV (4.2% p = 0.05). Among women age 50+ (typically excluded from screening in resource-poor settings because inexpensive treatment is not available), HPV positivity was 14.2% with a PPV of 13.9%. In Irun and similar settings where HPV does not decline with age, HPV-based screen-and-treat programs might be feasible for mid-adult women because prevalence is sufficiently low and positivity predicts elevated risk of more easily treated precancer. © 2011 UICC.

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