Journal of midwifery & women's health
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Irritable bowel syndrome is a gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. It adversely affects the quality of life for women who have it and is a significant health care burden. ⋯ It affects women more than men, and clear biological, psychological, and physical differences exist between the sexes, creating the need for a specialized approach to management in women. The objective of this article is to explore the pathophysiology of irritable bowel syndrome and how it relates specifically to women and to apply these differences to the diagnosis and treatment of irritable bowel syndrome in women.
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J Midwifery Womens Health · Nov 2012
ReviewCervical cancer screening in the era of human papillomavirus testing and vaccination.
Cervical cancer screening algorithms have changed with the introduction of testing for human papillomavirus (HPV) and better understanding of the natural history of HPV. This review was undertaken to present recent developments related to cervical cancer screening, with HPV testing as a focus. Specifically, guidelines now recommend initiating cervical cancer screening at age 21, stopping at age 65 to 70 if previous tests are normal, and screening no more than every 2 to 3 years. ⋯ Primary screening with HPV testing, although not yet approved in the United States, may serve to increase access to care for the millions of underserved women worldwide who bear most of the burden of cervical cancer. Despite clear guidelines from authoritative sources, many clinicians (including midwives) overscreen women. In cervical cancer screening, as in many areas of women's health care, performing tests that are unlikely to result in useful information may lead to harm.
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J Midwifery Womens Health · Jul 2012
Treatment options and recommendations to reduce preterm births in women with short cervix.
Premature shortening of the cervix, or short cervix, is the most predictive risk factor for preterm birth. Results of clinical studies of interventions to prevent preterm birth have shown that identifying at-risk women on the basis of cervical length versus obstetric history alone improves the likelihood of timely interventions with cervical cerclage or progesterone supplementation, improving outcomes. Debate continues over the use of cerclage; however, results of a meta-analysis of randomized controlled trials provide evidence to support its use in women who have history of prior preterm birth and who develop short cervix before 24 weeks' gestation. ⋯ Adverse events were comparable between women receiving progesterone and those receiving placebo. Recent guidelines issued by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend vaginal progesterone in women with no prior spontaneous preterm birth and cervical length of 20 mm or less at 24 weeks' gestation or earlier. Future studies will refine strategies for prevention of preterm birth to address other risk factors and determine the role of other interventions.