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Biomedical subjects

K Rosene-Montella

Publications and source records attributed to K Rosene-Montella.

9 recordsLinked to original sources
PubMed2006

A psychiatric mother-baby day hospital for pregnant and postpartum women.

Major depression and other psychiatric disorders are common during pregnancy and the postpartum period, yet these disorders remain largely under-diagnosed and under-treated. Developing programs that are uniquely tailored to meet the needs of perinatal psychiatric patients can improve both the quality and acceptability of care. In this report, we describe the development and implementation of a novel mother-baby day hospital service designed to meet the mental health needs of this special population, and present preliminary data regarding treatment acceptability and effectiveness. Our experience using this model of care for the past five years has suggested that specialized units such as this one represent an acceptable, effective, fiscally viable approach to the care of pregnant and postpartum psychiatric patients. Further research is needed to more thoroughly assess the effectiveness of this type of specialized perinatal service.

Adult↗
PubMed2002

The effect of obesity and position on heart rate in pregnancy.

OBJECTIVE: To determine the prevalence of resting sinus tachycardia among pregnant women during routine third-trimester antenatal visits, and to determine the relationship between body mass index (BMI) and heart rate. METHODS: In this cross-sectional study, pregnant women at 32-40 weeks' gestation were evaluated at routine antenatal visits between September 1996 and August 1997. Patients with medical disorders were excluded. Height, weight and pulse in both the sitting and the left lateral recumbent position were obtained. BMI was based on current weight, and those with a BMI of > or = 30 kg/m2 were classified as obese. Sinus tachycardia was defined as a heart rate of > or = 100 beats/min. RESULTS: The prevalence of tachycardia was 39% (n = 93) when seated, and 29% on the left side. The corresponding rates of sinus tachycardia when seated for obese (n = 31) and non-obese (n = 62) pregnant women were 58% and 29% (relative risk 2.0, 95% confidence interval 1.2, 3.3). However, the rates of tachycardia on the left side were not significantly different: 32% for obese and 27% for non-obese (relative risk 1.2, 95% confidence interval 0.6, 2.3). CONCLUSION: Resting tachycardia during routine antenatal visits may be more common than was previously recognized, and the majority of obese pregnant women are tachycardic when seated. When obese women are tachycardic in the seated position their heart rate should be reassessed after 5 min in the left lateral recumbent position.

Adult↗
PubMed2001

Drugs in pregnancy. Anticoagulants.

Pregnancy is a period of heightened coagulability and enhanced risk for thrombotic complications. Thromboembolism is the leading cause of maternal mortality. Anticoagulants are very useful during pregnancy for the acute treatment of venous thromboembolism and for the prevention of recurrent venous thromboembolism. They may also be beneficial in patients with thrombophilias, particularly among women who have experienced adverse pregnancy outcomes such as recurrent pregnancy loss. Anticoagulation is essential but problematic in the management of pregnant women with mechanical heart valve prostheses. When utilizing these medications among pregnant women the potential benefits must be balanced against the possibility of maternal haemorrhagic complications, adverse effects on the pregnancy or toxic effects on the fetus. This chapter summarizes current knowledge about the anticoagulant agents, their potential toxicities and their therapeutic role in pregnant women with various indications for anticoagulant therapy.

Abortion, Habitual↗
PubMed2000

Evaluation and management of infertility in women: the internists' role.

Interventions for infertility have greatly increased in number and sophistication. Women with multiple medical problems and women near or beyond menopause are now able to conceive. The internist will be called on to assess the risk that infertility interventions pose and to counsel patients accordingly. Knowledge of the medical illnesses associated with infertility, the types of infertility treatments available, and the medical complications of these interventions are required to properly assess this risk. Medical complications of infertility interventions can be direct effects of related drugs and technologies and indirect consequences of the induced pregnancy, multiple gestation, or associated medical conditions. This article reviews the definitions and scope of infertility, the interventions used for treatment of infertility, the medical complications of these interventions, the potential risks of fertility treatment in women unable to conceive spontaneously, and important issues for preconception counseling.

Counseling↗
PubMed2000

Teaching internal medicine residents about medical problems in pregnancy.

When they became aware that many of their internal medicine residents were not being routinely exposed to a representative range of medical illnesses in pregnancy, the authors set out to develop and implement a brief practical curriculum on the medical problems of pregnancy. They began with a retrospective chart review of 562 consultations with pregnant women and used their findings to develop nine 15-minute lectures that covered a majority of the concepts essential to the care of the medically compromised pregnant woman. Topics included hypertension in pregnancy, the febrile pregnant woman, and renal disease in pregnancy. The authors also created a learner handout, a teaching script, teaching cases, and a bibliography for each lecture. Residents have responded well to the curriculum, and their mean pre- and posttext scores have shown that the lectures improved their knowledge of obstetric medicine. This brief-lecture format may be adapted to other special topics in residency training and readily integrated into already-crowded training schedules.

Curriculum↗
PubMed1998

Alveolar-arterial oxygen gradient in acute pulmonary embolism in pregnancy.

OBJECTIVE: Our goal was to determine the prevalence of normal alveolar-arterial gradients in pregnant patients with documented pulmonary embolism. STUDY DESIGN: A retrospective chart review was performed on all pregnant women with pulmonary embolism at two large obstetric centers between 1990 and 1995. Alveolar-arterial gradients were calculated from room air arterial blood gas values and compared with values from patients who had been established as normal. RESULTS: Ten of 17 patients with pulmonary embolism identified had alveolar-arterial gradients that were normal. CONCLUSIONS: In our study 58% of pregnant women with documented pulmonary embolism had a normal alveolar-arterial gradient. This markedly differs from the published data in nonpregnant patients, in which the incidence of normal alveolar-arterial gradients in pulmonary embolism has ranged from 1.9% to 20%. This suggests that the alveolar-arterial gradient should not be used to determine the likelihood of pulmonary embolism in pregnant women because this could lead to the withholding of appropriate treatment for this life-threatening condition.

Adolescent↗
PubMed1998

Medical problems during pregnancy.

Dramatic physiologic changes are part of normal human pregnancy. The physiologic alterations of pregnancy have the potential to affect chronic diseases, to unmask subclinical conditions, or to alter the presentation and course of newly acquired illnesses. An update in selected topics of obstetric medicine follows, focusing on clinical entities in which there have been significant advances in diagnosis or management. Additionally, reviews of selected medical disorders, such as HIV infection and asthma, that are rising in incidence in women of reproductive age are included.

Asthma↗