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Biomedical subjects

K D Ramin

Publications and source records attributed to K D Ramin.

At least 19 recordsLinked to original sources
PubMed2001

Pneumonia in pregnancy.

Although the advent of broad-spectrum antibiotics has markedly improved the maternal outcomes of pneumonia complicating pregnancy, pneumonia remains a significant condition that may complicate pregnancy. This article has reviewed the inherent physiologic respiratory changes that accompany pregnancy and the common causes of pneumonia in the pregnant woman. The clinical course of bacterial pneumonia seems to be minimally altered by pregnancy, whereas viral pneumonia carries a significantly worse prognosis when encountered during gestation. Prompt diagnosis, the initiation of respiratory support, and appropriate antimicrobial/antiviral therapy are key components of therapy for women in whom pregnancy is complicated by pneumonia. Because preterm labor frequently accompanies pneumonia, women should be monitored closely for the occult onset of preterm labor and appropriate interventions initiated if indicated. Perhaps even more important than interventions to treat acute pneumonia are efforts directed at active immunization or prophylactic therapy to prevent the development of pneumonia in select patient populations. The combination of these efforts is essential to optimize medical care for pregnant women.

Female↗
PubMed2001

Disease of the gallbladder and pancreas in pregnancy.

Although maternal mortality and morbidity are substantially lower today than decades ago, perinatal mortality and morbidity secondary to gallbladder and pancreatic disease remain excessive. Improvements in perinatal mortality reflect improvements in neonatal intensive care because most of the morbidity stems from prematurity. Prompt recognition of cholelithiasis and pancreatitis and liberal hospitalization have been associated with a decline in poor outcomes. The decision to switch from medical to surgical management must be made individually, taking into account past history, gestational age, and the response of current disease to conservative therapy.

Acute Disease↗
PubMed2001

Cardiac disease in pregnancy.

Cardiovascular adaptations of pregnancy are generally well tolerated in the healthy gravida; however, these changes can place undue stress on women with underlying cardiovascular disease and can result in increased risk for morbidity and mortality. In this article, we will review issues related to preconceptional counseling, cardiovascular adaptations of pregnancy, and the prognosis and management of the gravida with cardiac disease in pregnancy.

Adaptation, Physiological↗
PubMed2001

Delayed postpartum hemorrhage: a rare presentation of carbon monoxide poisoning.

A 41-year-old woman presented with postpartum hemorrhage and altered mentation. A markedly elevated serum carboxyhemoglobin level was noted. Oxygen therapy was initiated with resolution of the patient's bleeding and improved mental status. Carbon monoxide poisoning is a rare and previously unreported cause of postpartum hemorrhage resulting from a unique pathophysiologic mechanism.

Adult↗
PubMed2000

Effect of vaginal pH on efficacy of misoprostol for cervical ripening and labor induction.

OBJECTIVE: We sought to evaluate whether vaginal pH has an effect on the relative efficacy of misoprostol for cervical ripening and labor induction. STUDY DESIGN: Thirty-seven gravid women with an unfavorable cervix and indication for labor induction were enrolled in this prospective, double-blind, observational study. Baseline assessments of cervicovaginal pH and Bishop score were made at the time of enrollment by an independent examiner. All patients received 50 microg misoprostol intravaginally every 6 hours for 12 hours. After the initial 12 hours of preinduction, a repeat Bishop score assessment was made by the same initial examiner. Patients not in active labor at 12 hours were placed on a standardized oxytocin induction regimen. Labor was managed by the on-call obstetric team, who remained blinded to pH assessment. Clinical outcomes were evaluated. Statistical analyses were made by the Student t test, the Fisher exact test, and linear regression analysis. RESULTS: Average initial vaginal pH was 4.8 +/- 0.5 (range, 3.5-7.0) for the study cohort. No significant differences were noted between those patients with low vaginal pH (< or =4.5) compared with those with high pH vaginal (>4.5) with respect to maternal age, parity, gestational age, or initial Bishop score. Similarly, Bishop score change over preinduction interval (5.6 vs 4.9), time to active labor (16.3 vs 17. 1 hours), time to complete dilatation (20.0 vs 19.9 hours), and time to delivery (21.0 vs 21.6 hours) were not significantly different between the low and high pH groups, respectively. Linear regression analysis revealed no significant association between vaginal pH and Bishop score change during preinduction interval, time to active labor, time to complete dilatation, or time to delivery. CONCLUSION: Vaginal pH does not appear to influence the efficacy of intravaginally administered misoprostol for cervical ripening and labor induction.

Adult↗
PubMed2000

Labor induction.

Labor induction has become commonplace in modern obstetrics. The increasing rate of labor induction has probably played a role in the increased rate of cesarean delivery observed in the United States during the past few decades. Clearly, the favorability of the cervix has a substantial impact on the potential success of any labor induction. Induction in the setting of an unfavorable cervix can result in prolonged induction, prolonged hospitalization, failed induction, and an increased cesarean delivery rate. In this modern era of healthcare reform and cost containment, the identification of therapeutic strategies to enhance the success and cost-effectiveness of labor induction are of great interest. Ongoing research is needed to advance our knowledge of the mechanisms of parturition and cervical ripening in order to direct interventions for labor induction more effectively.

Cervical Ripening↗
PubMed2000

Shoulder dystocia. Rotational maneuvers revisited.

Shoulder dystocia is an acute obstetric emergency that necessitates prompt, skillful intervention in order to prevent serious fetal trauma or death. Of the maneuvers described to deal with this difficult problem, rotational maneuvers are among the most ingenious. In spite of the effectiveness of these techniques, various technical deviations have led to the incorrect description and implementation of these maneuvers. This review of the rotational maneuvers used to counter shoulder dystocia gives particular attention to the techniques described originally.

Delivery, Obstetric↗
PubMed1999

Adrenal tumors and pregnancy.

Although adrenal tumors detected during pregnancy are extraordinarily rare, the pathophysiologic repercussions of untreated adrenal neoplasms are enormous to both mother and fetus. From our computer-based registry of pregnant patients from 1975 through 1996 (n = 30,246), four cases of adrenal neoplasms associated with pregnancy were identified (0.013%), analyzed, and compared with the current medical literature. Four women ages 36, 29, 22, and 21 years had adrenal neoplasms diagnosed with pregnancy. Patient 1 had an unsuspected pheochromocytoma identified at autopsy. At 27 weeks into her pregnancy the patient suffered a myocardial infarction, and both she and the fetus died. Patient 2 was incidentally found to have adrenal and pancreatic neoplasms on screening abdominal computed tomography for von Hippel-Lindau disease. The study identified a pregnancy. She elected to terminate the pregnancy and underwent resection of both tumors. She died 3 years later of metastatic islet cell cancer. Both of these patients had previously delivered healthy babies, but both pregnancies were complicated by hypertension. Patient 3 had a functional adrenal tumor identified initially by urinary aldosterone studies because of symptoms of severe hypertension, and patient 4 had an adrenal mass diagnosed via ultrasonography at 30 weeks' gestation because of concerns for right-sided pyelonephritis. These two women underwent careful monitoring throughout the remainder of their pregnancies with eventual delivery of healthy babies. Both women later underwent successful operative resection of benign adrenal adenomas. Adrenal neoplasms discovered during pregnancy are rare. The onus, however, is on physicians to consider this diagnosis in pregnant women with hypertension, headaches, or other manifestations of adrenal disorders. Surgical management of identified adrenal lesions is thereafter straightforward. Missing the diagnosis has grave implications for these young women and their fetuses.

Adenoma, Islet Cell↗
PubMed1999

Ultrasonographic assessment of cervical length in triplet pregnancies.

OBJECTIVE: Our goal was to evaluate the utility of ultrasonographic assessment of cervical length in the management of triplet pregnancies and to compare these measurements with previously reported data for singleton pregnancies. STUDY DESIGN: The maternal records for all triplet pregnancies managed at the Mayo Medical Center from January 1993-January 1998 were reviewed. Cervical length assessment was undertaken at regular intervals during each pregnancy according to an established real-time transperineal ultrasonographic technique. Presence or absence of cervical funneling was noted at the time of the examination. Obstetric management and outcome data were assessed. RESULTS: Thirty-two triplet pregnancies were managed at our institution between January 1993 and January 1998. Average duration of pregnancy (+/-SD) was 32.4 +/- 2.3 weeks. Progressive cervical shortening was noted with advancing gestational age; average cervical lengths (+/-SD) were 42.0 +/- 5.0 mm at 10 weeks, 37.0 +/- 8.0 mm at 20 weeks, 26.0 +/- 10.0 mm at 25 weeks, and 21.0 +/- 7.0 mm at 30 weeks. Comparison of triplet cervical length measurements with reported data from singleton pregnancies revealed a significant difference between the singleton and triplet data, respectively, at both 24 weeks (35.2 +/- 8.3 mm vs 25.0 +/- 8.0 mm, P <.001) and 28 weeks (33.7 +/- 8.5 mm vs 28.0 +/- 11.0 mm, P <.005). Cervical funneling was noted in 3 women with an average of 27 days from onset to delivery. CONCLUSIONS: Ultrasonographic assessment of cervical length is a useful adjuvant in the management of the triplet gestation. Triplet cervical length measurements are significantly different from those reported for gestational age-matched singleton pregnancies. Premature cervical shortening and the presence of cervical funneling are harbingers of premature delivery and should necessitate obstetric intervention.

Cervix Uteri↗
PubMed1999

Nicotine patch use in pregnant smokers: nicotine and cotinine levels and fetal effects.

OBJECTIVE: The aims of this study were (1) to determine whether nicotine patch therapy for pregnant women smokers acutely compromises fetal well-being and (2) to determine the serum and urine nicotine and cotinine levels in pregnant women while smoking, while abstinent from smoking, and while receiving nicotine patch therapy compared with levels in a historical control group of nonpregnant women smokers who abstained from smoking while receiving comparable doses of nicotine patch therapy. STUDY DESIGN: Pregnant cigarette smokers (n = 21) aged >/=18 years whose fetuses were beyond 24 weeks' gestational age were recruited for this 1-sample, repeated-measures study. Serial measurements of the mother and fetus were made at baseline while the mother was smoking, while abstaining from smoking, and while using nicotine patch therapy for 4 days in a special care hospital unit. Nonpregnant women smokers of similar age were used for comparison. Morning and afternoon serum and 24-hour urine levels of nicotine and cotinine were obtained during hospitalization. Indicators of fetal well-being assessed were fetal heart rate and reactivity, systolic/diastolic ratio of blood flow in the umbilical artery, and fetal activity seen on ultrasonography and quantitated as biophysical profiles. RESULTS: No evidence of fetal compromise was seen during the inpatient phase while nicotine patch therapy was administered. Steady state (inpatient day 4) serum levels of nicotine were similar to smoking levels and to those seen in historical control subjects (ie, nonpregnant women of child-bearing age who were abstinent from smoking and who used the same nicotine patch). Morning serum cotinine levels were significantly higher (P =.038) in the nonpregnant subjects than in the pregnant subjects, whereas afternoon levels were not significantly different. Steady state urinary levels of nicotine and cotinine were also not significantly different in pregnant versus nonpregnant patients. On inpatient days 2, 3, and 4, when the women were not smoking and were wearing the nicotine patch, the morning fetal heart rates were significantly reduced relative to baseline when the subjects were smoking. CONCLUSIONS: Nicotine patch therapy was not found to be associated with indications of fetal compromise during the in-hospital phase of nicotine patch therapy in pregnant smokers who were abstaining. Although not conclusive because of the small sample sizes, serum nicotine levels (morning and afternoon) appear similar in pregnant and nonpregnant subjects and similar for both groups when smoking (baseline) as compared to the steady state of nicotine patch use.

Administration, Cutaneous↗
PubMed1999

Diabetic ketoacidosis in pregnancy.

Diabetic ketoacidosis (DKA) remains a medical emergency with high maternal and fetal mortality. Prompt recognition and resuscitative therapy markedly improves outcome. The pathophysiology and management of DKA in pregnancy is discussed in detail in this article.

Diabetic Ketoacidosis↗
PubMed1999

The prevention and management of eclampsia.

Hypertensive disease remains second only to embolic phenomena as a leading cause of maternal mortality. This article covers the major physiologic and pathologic findings to be considered when managing pregnant women with eclampsia. Attention to detail and an increased degree of suspicion will improve fetal and maternal outcomes.

Eclampsia↗
PubMed1999

Fallopian tube prolapse after hysterectomy.

BACKGROUND: Fallopian tube prolapse is reported to most commonly occur after vaginal hysterectomy. Both diagnosis and management have varied, resulting in differing efficacies of treatment. METHODS: We reviewed the presentation, diagnosis, management, and outcomes of 18 cases of tubal prolapse in 17 women. RESULTS: Most cases (65%) occurred after abdominal hysterectomy. The post-hysterectomy course was complicated by cuff cellulitis in three women, an infected cuff hematoma in one, and post-extubation pulmonary edema in one; four were observed for elevated temperature only. At presentation, 44% complained of dyspareunia, 39% vaginal bleeding, 33% vaginal discharge, 28% abdominal pain, and 28% were asymptomatic. Seven women had vaginal excision (one requiring an additional abdominal procedure), three had laparotomy with salpingectomy, and seven (41%) had spontaneous disappearance of prolapsed fallopian tube without treatment. CONCLUSIONS: In our series, tubal prolapse most commonly occurred after abdominal hysterectomy. Moreover, women with tubal prolapse may be asymptomatic, and observation alone may lead to resolution.

Abdominal Pain↗
PubMed1999

Single-shot fast spin-echo MR imaging of the fetus: a pictorial essay.

Ultrasonography (US) is the modality of choice for prenatal screening, but occasionally additional imaging information is needed. Magnetic resonance (MR) imaging is an attractive alternative but until recently has been limited by motion artifact. Single-shot fast spin-echo MR imaging was used to depict normal and abnormal anatomy in 26 fetuses. Thirteen studies were performed for maternal indications and 13 were performed to evaluate fetal abnormalities identified or suspected at US. Three of the fetal abnormalities involved the central nervous system (CNS) and 10 involved other anatomic sites. Results were correlated with findings at postnatal clinical examination, imaging, and pathologic analysis. MR imaging demonstrated normal fetal anatomy without substantial motion artifact. CNS structures were well visualized as early as 18-20 weeks gestation, as were most other normal anatomic structures except the heart. MR imaging also allowed characterization of a variety of abnormalities of the CNS (Arnold-Chiari malformation, Walker-Warburg syndrome, amniotic band syndrome) as well as of other structures (renal agenesis, multicystic dysplastic kidney, abdominal masses, severe limb-body wall defect, clubfoot with arthrogryposis, diaphragmatic hernia). US findings were confirmed in most cases, and additional information about the precise diagnosis or the severity or location of the anomaly often helped guide clinical management. Single-shot fast spin-echo MR imaging of the fetus is a useful adjunct to US in difficult diagnostic situations.

Congenital Abnormalities↗