ABSTRACT
There is growing interest in low molecular weight heparin for the management of thromboembolic disease in pregnancy. Greater understanding of the risk of thromboembolic disease versus the risk of various management practices is urgently needed to reduce maternal mortality and embryopathy in the fetus.
Subject(s)
Anticoagulants/therapeutic use , Pregnancy Complications, Hematologic/drug therapy , Thrombosis/drug therapy , Adult , Female , Heparin/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Pregnancy , Pregnancy Complications, Hematologic/epidemiology , Risk Factors , Thrombosis/epidemiology , Warfarin/therapeutic useABSTRACT
Aneurysmal subarachnoid hemorrhage in a pregnant woman is a rare catastrophic situation that places both the mother and the fetus at high risk. When this situation arises, numerous relevant issues must be individualized in the effort to reduce hazards threatening both the mother and the fetus. These issues have been addressed in terms of the published experience and in terms of modern obstetric, anesthetic, and neurologic surgery technology.
Subject(s)
Intracranial Aneurysm/surgery , Pregnancy Complications, Cardiovascular/surgery , Subarachnoid Hemorrhage/surgery , Anesthesia, General , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/surgery , Female , Fetal Monitoring , Humans , Infant, Newborn , PregnancyABSTRACT
The purposes of this investigation were to: (1) estimate the prevalence of illicit drug use within the prenatal population of a midwestern suburban ambulatory care center; (2) explore the relationship between nurses' judgments of patient illicit drug use and urine toxicology results; and (3) determine if a difference exists between nurses' judgments of illicit drug use by private physicians' patients (PPP) and nurses' judgments of illicit drug use by resident physicians' patients (RPP). For a 16-week period, all new prenatal patients (N = 189) were included in this study; 78 (41%) were in the RPP group and 111 (59%) were in the PPP group. Urine remaining from routine urinalysis was assayed for seven drugs or drug classes. Fourteen (7.5%) subjects tested positive for illicit drugs, 8 (10.3%) in the RPP group, and 6 (5.4%) in the PPP group (chi 2, P greater than .33). Using a Likert-type scale, nurses rated the likelihood of a positive result of each patient's urine test. Nurses' judgments of patient illicit drug use and positive results were related, r = .28. Nurses were more likely (P less than .0001) to suspect residents' patients of illicit drug use than private physicians' patients.
Subject(s)
Illicit Drugs , Nurses/psychology , Pregnancy Complications/epidemiology , Substance-Related Disorders/epidemiology , Adult , Ambulatory Care Facilities , Analysis of Variance , Chi-Square Distribution , Female , Humans , Illicit Drugs/urine , Internship and Residency , Judgment , Medical Staff, Hospital , Midwestern United States , Pregnancy , Pregnancy Complications/urine , Prevalence , Substance-Related Disorders/urineSubject(s)
Abnormalities, Drug-Induced/etiology , Hypertrichosis/chemically induced , Maternal-Fetal Exchange , Minoxidil/adverse effects , Abnormalities, Multiple/chemically induced , Captopril/adverse effects , Female , Humans , Hypertension/drug therapy , Hypertrichosis/congenital , Infant , Male , Pregnancy , Propranolol/adverse effectsABSTRACT
An antepartum diagnosis of vasa previa was considered in a patient in whom ultrasound revealed pulsatile loops of cord overlying the cervical os. This diagnosis was confirmed at the time of cesarean delivery. We offer a literature review of vasa previa and make recommendations for using ultrasonography to diagnose vasa previa.
Subject(s)
Placenta/blood supply , Ultrasonography , Uterine Hemorrhage/etiology , Adult , Cesarean Section , Female , Humans , Pregnancy , Prenatal DiagnosisSubject(s)
Embolism, Amniotic Fluid/complications , Pregnancy Complications, Cardiovascular , Adult , Anesthesia, Obstetrical , Blood Pressure , Bupivacaine , Cesarean Section , Diazepam , Electrocardiography , Embolism, Amniotic Fluid/physiopathology , Embolism, Amniotic Fluid/therapy , Female , Heart Rate , Humans , Hypertension/etiology , Hypertension/therapy , Hypotension/etiology , Infusions, Parenteral , Intraoperative Period , Ketamine , Lidocaine/therapeutic use , Nitroglycerin/therapeutic use , Postoperative Period , Pregnancy , Tachycardia/etiology , Tachycardia/therapyABSTRACT
Sonographic examination of the gallbladder in two patients with preeclampsia and right upper quadrant pain demonstrated notable thickening of the gallbladder wall. The sonographic abnormality and clinical symptoms completely resolved after delivery and/or medical management of the preeclampsia. This finding is probably secondary to the hypoalbuminemia characteristic of preeclampsia and should not be mistaken for intrinsic gallbladder disease.
Subject(s)
Gallbladder/pathology , Pre-Eclampsia/pathology , Adult , Cholelithiasis/diagnosis , Edema/etiology , Female , Gallbladder Diseases/diagnosis , Gallbladder Diseases/etiology , Humans , Pain/etiology , Pregnancy , Serum Albumin/deficiency , UltrasonographyABSTRACT
A pilot study was designed to determine whether a synergistic ability to produce sister chromatid exchanges exists between ultrasound and mitomycin C, an alkylating agent known to induce sister chromatid exchanges. Bromodeoxyuridine-containing cells from human lymphocyte cultures were randomized into one of four exposures: (1) unexposed controls, (2) 20 minutes of pulsed ultrasound (3.5 MHZ), (3) mitomycin C alone, or (4) mitomycin C and 20 minutes of pulsed ultrasound. The mean sister chromatid exchange frequencies were 6.7 control cells, 7.5 cells exposed only to ultrasound, 8.1 cells treated with both ultrasound and mitomycin C, and 10.4 cells treated with mitomycin C alone. Neither X2 tests for differences in the four distributions nor analysis of variance for interaction between ultrasound and mitomycin C was significant. Our results suggest that individuals receiving alkylating agents are not likely to be highly susceptible to any deleterious effects of ultrasound. However, these results remain tentative pending repetition of studies and development of more appropriate in vitro exposure systems.
Subject(s)
Crossing Over, Genetic , Mitomycins/adverse effects , Sister Chromatid Exchange , Ultrasonics/adverse effects , Adult , Crossing Over, Genetic/drug effects , Female , Humans , In Vitro Techniques , Mitomycin , Pilot Projects , Sister Chromatid Exchange/drug effectsABSTRACT
Acute respiratory failure developed in a 19-year-old primigravida 7 hours after undergoing cesarean section. The diagnosis of amniotic fluid embolism was established by viewing fragments of vernix caseosa in a pulmonary artery blood sample. Forty-eight hours after the cytologic diagnosis had been made, amniotic fluid material was no longer present in pulmonary arterial blood. The patient underwent supportive care in an intensive care setting and recovered completely.
