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Biomedical subjects

Edward R Yeomans

Publications and source records attributed to Edward R Yeomans.

10 recordsLinked to original sources
PubMed2006

Chronic renal disease in pregnancy.

The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).

Chronic Disease↗
PubMed2005

Effects of nuchal cord on birthweight and immediate neonatal outcomes.

Our objective was to ascertain if nuchal cord is associated with adverse neonatal outcomes. Using a retrospective database of term neonates, outcomes were compared among infants with 0, 1, and 2 or more loops of cord encircling the neck. Of 4426 neonates, 3651 served as controls, 691 had one loop, and 84 had two or more loops. There were no significant differences in the mean birthweight, the frequency of nonreassuring fetal heart rate patterns, operative vaginal deliveries, or 5-minute Apgar scores of < 7. The cesarean delivery rate was significantly different among the three groups and was the highest among the group of women whose fetus had no nuchal cord ( p < 0.01). A nuchal cord at term is not associated with untoward pregnancy outcomes.

Apgar Score↗
PubMed2005

Diabetic ketoacidosis in pregnancy.

OBJECTIVE: The development of diabetic ketoacidosis in pregnancy is a medical emergency, requiring treatment in an intensive care setting. Both the mother and the fetus are at risk for significant morbidity and mortality. Physiologic changes unique to pregnancy provide a background for the development of diabetic ketoacidosis. An understanding of these physiologic changes assists in the management of the two patients being treated. Treatment of the patient with diabetic ketoacidosis includes insulin therapy and careful fluid management; recommendations for management are presented. PATIENTS: Pregnant women, either with preexisting diabetes or with diabetes diagnosed during pregnancy. CONCLUSIONS: Prompt recognition of the clinical manifestations of diabetic ketoacidosis, followed by appropriate, timely treatment will optimize outcome for the pregnant woman and her fetus.

Acidosis↗
PubMed2005

Physiologic changes in pregnancy and their impact on critical care.

OBJECTIVES: To describe the major pregnancy-induced physiologic changes that affect the care of patients who are critically ill. METHODS: We reviewed relevant textbooks and articles pertaining to physiologic alterations produced by pregnancy. Those changes that have a bearing on patients admitted to an intensive care unit were abstracted, summarized, and organized by organ system. CONCLUSIONS: Several organ systems manifest significant change in function during pregnancy. The cardiovascular and pulmonary systems are the two most important with regard to critical care.

Critical Care↗
PubMed2003

Gestational diabetes: a field of controversy.

UNLABELLED: Many clinicians in the United States routinely screen all pregnant women in their practices for gestational diabetes. Recently, the US Preventive Services Task Force re-emphasized that such screening is not supported by rigorous scientific evidence. Recommendations for diagnosis and management are based on an even scantier scientific foundation. Although this review questions several aspects of current dogma, it, too, is based on the frequently flawed existing data. It is surprising how, in spite of an abundance of published information on the subject, we continue to be ignorant of the real benefits of the widespread practice of screening and treating for gestational diabetes. The authors hope that the results of a randomized clinical trial, now in progress, will help to resolve some of the controversies surrounding gestational diabetes. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to describe the controversy surrounding the significance of gestational diabetes, to break down the data regarding the efficacy of screening for gestational diabetes, and to outline potential treatment options for gestational diabetes.

Diabetes, Gestational↗