Biomedical subjects

A G Witlin

Publications and source records attributed to A G Witlin.

22 records · Page 2Linked to original sources

PubMed1997

Hypertension in pregnancy: current concepts of preeclampsia.

Hypertensive disorders (gestational hypertension, preeclampsia, chronic hypertension, superimposed preeclampsia) are the most common medical complications of pregnancy and constitute a major cause of maternal and perinatal morbidity and mortality. Prediction of those women destined to develop preeclampsia remains elusive. The benefits of calcium supplementation for prevention of preeclampsia are encouraging; however, the definitive study is not yet complete. Aspirin therapy for high-risk has not been helpful; results of therapy for high-risk women are pending. More experience is being gained with antihypertensive therapy and expectant management in severe preeclampsia. Conservative management of severe preeclampsia, when performed in a tertiary care center, may benefit a select group of women and their fetuses.

Antihypertensive Agents↗

PubMed1996

Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome in pregnancy: review of 11 cases.

OBJECTIVE: Little information exists regarding thrombotic thrombocytopenic purpura and hemolytic uremic syndrome during pregnancy. We report a series of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome complicating pregnancy, with emphasis on diagnosis and management of this rare disorder. STUDY DESIGN: Between January 1988 and February 1996, 11 women with either thrombotic thrombocytopenic purpura (n = 8) or hemolytic uremic syndrome (n = 3) were evaluated. Clinical and laboratory findings and maternal and neonatal outcomes were recorded from the medical records. RESULTS: Eight of the 11 women were in the third trimester or peripartum period, and three were seen before fetal viability. Treatment included fresh-frozen plasma in all women, plasmapheresis (n = 8), packed red blood cells (n = 9), and platelet transfusions (n = 5); 1 patient required splenectomy. There were two maternal deaths. Of the 9 surviving women, 4 had chronic renal disease, 1 of whom also had residual neurologic deficit. Preterm delivery occurred in 5 of 8 pregnancies continuing beyond 20 weeks. Indications for delivery in these 5 women included worsening maternal medical disease, nonreassuring fetal testing, and spontaneous preterm labor. Six of 8 women with viable fetuses underwent cesarean delivery. These 6 infants were born in good condition without thrombocytopenia. Of the remaining 2 infants delivered vaginally, one was healthy at 35 weeks and the other was stillborn. CONCLUSION: Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome complicating pregnancy is associated with high maternal mortality and long-term morbidity. Preterm delivery and intrauterine fetal death are frequent complications of these pregnancies. Improved survival after this disorder has been attributed to aggressive treatment with plasma transfusion or plasmapheresis.

Adolescent↗

PubMed1995

Postpartum ovarian vein thrombosis after vaginal delivery: a report of 11 cases.

OBJECTIVE: To review and characterize the presentation of postpartum ovarian vein thrombosis after vaginal delivery. METHODS: We reviewed medical records of patients with the prior diagnosis of septic pelvic thrombophlebitis, deep vein thrombosis, and pulmonary embolism associated with pregnancy. The study covered the 10-year period from July 1984 through August 1994 and included women hospitalized at E.H. Crump Women's Hospital, Regional Medical Center, University of Tennessee, Memphis, Tennessee. RESULTS: During the study period, there were 76,858 deliveries: 13,109 cesareans and 63,749 vaginal deliveries. Eleven patients had documented postpartum ovarian vein thrombosis after vaginal delivery. Ten patients were readmitted an average of 7.6 days after delivery (range 3-17). The diagnosis was documented by computed tomography (CT) scan or ultrasound in ten women and laparotomy in one. Nine patients were readmitted with the presumptive diagnosis of endometritis, the other two with the presumptive diagnosis of pyelonephritis. Nine were treated initially with ampicillin, gentamicin, and clindamycin. Heparin therapy was added when failure of clinical response was noted. No patient defervesced within 24 hours of beginning heparin therapy; only two patients defervesced within 48 hours, and the remaining patients became afebrile at an average of 6.8 days (range 4-18, median 5). CONCLUSION: The diagnosis of ovarian vein thrombosis should be considered early in the care of patients readmitted with a diagnosis of endometritis after vaginal delivery. If prompt defervescence does not occur with aggressive intravenous antibiotic therapy, a CT scan should be obtained in a timely manner for prompt diagnosis and therapy. Our findings do not support the time-honored rule that septic pelvic thrombophlebitis and ovarian vein thrombosis respond within 24-48 hours to therapeutic anticoagulation with heparin.

Adolescent↗

PubMedDate not supplied

Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology.

The objective of this study was to review and characterize the presentation, diagnostic dilemmas, management, and prognosis of postpartum septic pelvic thrombophlebitis. Medical records of postpartum women with the diagnosis of septic pelvic thrombophlebitis were reviewed for the 8-year period 1986-1994. Cases of documented ovarian vein thrombosis or those with other pelvic pathology on imaging study were excluded. Thirty-one women, four following vaginal delivery and 27 following cesarean delivery, with a final diagnosis of septic pelvic thrombophlebitis were identified. All patients demonstrated refractory febrile morbidity (mean 5.5 +/- 1.9 days prior to instituting heparin therapy) despite multiagent antimicrobial therapy with ampicillin, gentamicin, and clindamycin. Imaging studies (CT and/or ultrasound) were performed in 20 women and revealed no pelvic pathology. The patients required an average of 4.7 +/- 2.1 days (median 5, range 1-9 days) of heparin therapy before defervescence. Heparin levels were therapeutic at a mean of less than 24 h (range 6-24 h). The average dose of heparin required was 16.0 +/- 3.0 U/kg/h. Nine women had 13 subsequent pregnancies without recurrent thromboembolic complications. Currently available imaging studies cannot diagnose the entity we now define as septic pelvic thrombophlebitis (once cases of ovarian vein thrombosis are excluded). Our findings do not support the time-honored rule that septic pelvic thrombophlebitis responds within 24-48 h to therapeutic anticoagulation with heparin. Therefore, criteria other than imaging studies or immediate defervescence following heparin therapy are necessary for diagnosis of septic pelvic thrombophlebitis. A more appropriate terminology for septic pelvic thrombophlebitis should be refractory postpartum fever of undetermined etiology.

Adolescent↗