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Biomedical subjects

R M Pitkin

Publications and source records attributed to R M Pitkin.

At least 37 records · Page 2Linked to original sources
PubMed1991

Screening and detection of congenital malformation.

Congenital malformations often occur sporadically and unpredictably, and a method of population screening to identify at-risk pregnancies would be of great value. Routine ultrasonography has some appeal in this regard. Unfortunately, the literature indicates a relatively poor sensitivity, with usually 30% or less of malformations identified or suspected by this means. Substantially better results have been described with ultrasonography targeted on the basis of screening ultrasonography or clinical findings, but these studies involve highly selected subjects examined carefully by experienced ultrasonographers, and their results are not relevant to population screening. A questionnaire survey of experts in the field indicated disagreement with the separation of screening and targeted ultrasonography, widely varying estimates of the accuracy of either, and average changes of $209 and $263, respectively. Theoretical considerations of the various types of malformations, their frequencies, and the likelihood of ultrasonographic detection reveal a minority of defects in which ultrasonography is both accurate and useful clinically. Ultrasonography seems to be of little potential as a means of screening for congenital malformation because of relatively low sensitivity and uncertain cost effectiveness.

Congenital Abnormalities↗
PubMed1991

Once a cesarean?

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Cesarean Section↗
PubMed1990

Pregnancy and congenital heart disease.

Congenital heart disease as a complicating factor in pregnancy has assumed increasing clinical importance because improved techniques of surgical repair have resulted in a larger proportion of affected women living to the reproductive age. The most serious forms are those associated with pulmonary hypertension (such as the Eisenmenger syndrome), which carry a prohibitively high risk of maternal death. Complex forms of cyanotic heart disease, of which the commonest is the tetralogy of Fallot, are only slightly less dangerous. It has recently been recognized that children born to women with congenital heart disease are at increased risk of having cardiac defects; fetal echocardiography is therefore an important diagnostic test. Optimal care of the pregnant woman with congenital heart disease is best provided by a team consisting of internist-cardiologist, obstetrician-perinatologist, obstetric anesthesiologist, and ultrasonographer-echocardiographer.

Delivery, Obstetric↗
PubMed1988

Labor pain: a comparison of parturients in a Dutch and an American teaching hospital.

Women giving birth in two university hospitals, one in the Netherlands and the other in the United States, were surveyed postpartum regarding expectations of pain in labor and availability of medication for its relief, perceptions of the painfulness of labor, and use of analgesia and anesthesia. American women expected labor to be more painful, anticipated that they would receive medication for it, and did receive such medication in significantly greater proportions compared with Dutch parturients. These findings point to fundamental, culturally determined differences between these two societies with respect to women's views of the painfulness of childbirth.

Analgesia↗
PubMed1987

Fetal death: diagnosis and management.

Death of the fetus after 20 weeks of gestation complicates about 1% of pregnancies. Of various means of diagnosing fetal life and death, real-time ultrasound visualization of the fetal heart is the most accurate. Delivery of the dead fetus can be effected by various means, but in most instances, at least before 28 weeks and perhaps thereafter as well, the simplest and most effective method is with prostaglandin vaginal tablets. A variety of conditions are known to cause fetal death or increase the risk that it will happen, but these account for only about 50% of cases. Four special tests may identify a cause of the "unexplained stillbirth" in the other 50% of cases. These tests include karyotype, listerial culture, fetomaternal hemorrhage, and lupus anticoagulant.

Amniotic Fluid↗