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Biomedical subjects

A Y Frangieh

Publications and source records attributed to A Y Frangieh.

5 recordsLinked to original sources
PubMed1997

Cerebrovascular disorders complicating pregnancy--beyond eclampsia.

OBJECTIVE: Our purpose was to investigate the problems encountered in the diagnosis and management of cerebrovascular disorders associated with pregnancy and the puerperium. STUDY DESIGN: Pregnancies complicated by cerebrovascular disorders were identified by retrospective chart review (1985 to 1995). Events associated with trauma, neoplasm, drug ingestion, and infection were excluded. RESULTS: The study population comprised 24 women with a variety of cerebrovascular disorders: 14 with infarction (5 arterial, 9 venous), 6 with intracranial hemorrhage (3 anatomic malformation, 3 unknown etiology), 3 with hypertensive encephalopathy, and 1 with an unruptured aneurysm. Blood pressure reflected physical condition at presentation and did not predict diagnosis or outcome except in the 3 women with hypertensive encephalopathy. Only 4 of 14 women with infarction and 1 of 6 with intracranial hemorrhage had a diastolic blood pressure > or = 110 mm Hg. Presumption of eclampsia delayed the diagnosis in 10 women (41.7%). In addition, patient delay in seeking medical attention complicated 10 cases. After review, none of the adverse maternal outcomes were deemed preventable by earlier physician intervention. Seven maternal deaths occurred (29.2%). Neonatal outcome was related to the gestational age and the maternal condition at presentation. CONCLUSION: Cerebrovascular disorders are an uncommon and unpredictable complication of pregnancy that are associated with substantial maternal and fetal mortality. Suspected eclampsia unresponsive to magnesium sulfate therapy warrants an immediate neuroimaging study. Interestingly, in women with intracranial hemorrhage, severe hypertension was not an associated predictive factor.

Adolescent↗
PubMed1996

Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.

OBJECTIVE: Our purpose was to compare the maternal outcome of pregnancies complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, partial HELLP syndrome, or severe preeclampsia. STUDY DESIGN: In a retrospective cohort study we reviewed the maternal charts of 316 women with HELLP syndrome or severe preeclampsia managed at our perinatal center between July 1, 1992, and June 30, 1995. HELLP syndrome was strictly defined by previously published laboratory criteria. Women were divided into three groups: HELLP syndrome (n = 67), partial HELLP syndrome (one or two but not all three features of HELLP syndrome, n = 71), and severe preeclampsia (no features of HELLP syndrome, n = 178). Results were compared by chi 2 analysis and one-way analysis of variance. RESULTS: Mean gestational ages at delivery in the HELLP, partial HELLP, and severe preeclampsia groups were, respectively, 31.7, 32.7, and 34.5 weeks (p < 0.001 between HELLP and severe preeclampsia). There was one maternal death from intracerebral hemorrhage in the HELLP group. In women with HELLP syndrome there was a higher incidence of cesarean section (p < 0.05), disseminated intravascular coagulation (p < 0.001), and need for transfusion (p < 0.001) than in the other two groups. CONCLUSIONS: Higher incidences of maternal complications in women with HELLP syndrome stress the importance of strict criteria for the definition of HELLP syndrome. Women with partial HELLP syndrome should be studied and managed separately from women with complete HELLP syndrome.

Adult↗
PubMed1996

Management of severe preeclampsia.

Preeclampsia affects two patients, the mother and the fetus. Traditionally, women with severe preeclampsia have been delivered without delay, regardless of fetal considerations. Although delivery is appropriate therapy for the mother, aggressive management with immediate delivery of a fetus remote from term leads to high neonatal mortality and morbidity resulting from prematurity. Recent studies have shown favorable neonatal outcomes after conservative management of severe preeclampsia. Candidates for conservative management should be selected carefully and managed with intensive maternal and fetal monitoring at a tertiary perinatal center.

Delivery, Obstetric↗