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L Sanchez-Ramos

Publications and source records attributed to L Sanchez-Ramos.

67 records · Page 4Linked to original sources
PubMed1991

Urinary calcium as an early marker for preeclampsia.

Women who develop preeclampsia during pregnancy excrete less calcium than healthy pregnant women. Whether this reduction in calcium excretion precedes or follows hypertension is unknown. We prospectively measured urinary calcium excretion in 103 consecutive nulliparous women at risk for preeclampsia and presenting for prenatal care before 24 weeks' gestation. Serial 24-hour urine specimens were obtained at 10-24 weeks, 25-32 weeks, and 33 weeks to term. After delivery, the charts were reviewed for the presence of preeclampsia and gestational hypertension. At the first collection, patients who later developed preeclampsia excreted less urinary calcium (169 +/- 30 mg/24 hours; mean +/- standard error of the mean) than those who remained normotensive (298 +/- 15 mg/24 hours) (P less than .05); this reduction persisted throughout gestation. Using a receiver operator curve, we calculated a predictive threshold calcium value for hypertension of 195 mg/24 hours. The difference in the incidence of preeclampsia between pregnant women with calcium excretion values at or below 195 mg/24 hours (87%, 95% confidence interval 52-98%) and those with values above that level (2%, confidence interval 0.3-8%) was highly significant (Fisher exact test, P less than .0001). The 95% lower limit of relative risk for preeclampsia in patients with a calcium excretion equal to or below 195 mg/24 hours in the first collection was 9.4. These observations suggest a pathophysiologic role for altered urinary calcium excretion in women with preeclampsia that may contribute to the early identification of patients at risk for this disease.

Adolescent↗
PubMed1990

Antibiotic therapy in preterm premature rupture of membranes: a randomized, prospective, double-blind trial.

The use of antibiotics in the management of preterm, premature rupture of membranes remains controversial. By use of a prospective randomized double-blind design we investigated the maternal-fetal benefits associated with antibiotic therapy in 85 women with premature rupture of membranes at 34 weeks' estimated gestational age. In the treatment group 40 patients received intravenous mezlocillin for 48 hours followed by oral ampicillin until delivery. In the control group 45 patients received intravenous and oral placebo. Patients who received antibiotics had chorioamnionitis and endometritis less frequently than the control group (p less than 0.01 and p less than 0.05). Pathologic examination of the placentas showed a lower incidence of chorioamnionitis in the treatment group (p less than 0.05). The period from premature rupture of membranes to delivery (latency) was prolonged with antibiotics (p less than 0.05) and resulted in significant weight gain in the infants in the antibiotic group (p less than 0.0001). These infants also had higher 1- and 5-minute Apgar scores. Clinically suspected sepsis, respiratory distress syndrome, intraventricular hemorrhage, perinatal death rate, and prolonged hospitalization (greater than 30 days) were also increased in the control group.

Administration, Oral↗
PubMed1990

Reducing cesarean sections at a teaching hospital.

A department-wide effort to reduce the cesarean section rate at the University Medical Center of Jacksonville (Florida) began in 1987. University Medical Center, a teaching hospital with approximately 4500 annual deliveries, serves an almost exclusively indigent obstetric population. Overall, the cesarean section rate declined from 28 per 100 deliveries in 1986 to 11 per 100 in 1989. Decreasing the number of repeat cesarean sections played an important role in reducing total cesarean deliveries. In 1986 32% of women with prior cesarean sections underwent a trial of labor. By 1989 this proportion had increased to 84%. In 1986 65% of women undergoing a trial of labor were delivered vaginally. By 1989 this proportion had increased to 83%. For these reasons the proportion of patients who had repeat cesarean sections dropped from 8% in 1986 to 3% in 1989. Changing approaches to the evaluation and management of dystocia and fetal distress also helped to lower the overall cesarean section rate. In 1986 cesarean sections for at least one of these two indications accounted for 14% of all deliveries. By 1989 this percentage had dropped to 4%. Because selective criteria for vaginal delivery of fetuses in breech presentation were maintained, incremental increased rates of vaginal breech delivery had only a minimal impact on lower overall cesarean section rates. The reduction in the number of cesarean sections was accomplished without compromising neonatal outcomes. In fact, during this 4-year period neonatal mortality rates actually decreased; neonatal morbidity rates remained stable. Our experience suggests that cesarean section rates can be substantially reduced without compromising the newborn.

Birth Weight↗
PubMed1990

Effect of angiotensin II infusion during normal pregnancy on flow velocity waveforms in the uteroplacental and umbilical circulations.

Women destined to develop preeclampsia show an increased systemic pressor response to infused angiotensin II, and the angiotensin sensitivity test has been accepted as an appropriate means of identifying these women. However, the effect of angiotensin II infusion on uteroplacental blood flow is unknown and may be deleterious. Patients undergoing angiotensin sensitivity tests as part of a protocol examining the effect of aspirin on the incidence of preeclampsia were studied with Doppler velocimetry performed before and during the angiotensin II infusion. Fetal well-being was documented with biophysical profiles performed before and after the infusions. Neither the systolic-diastolic ratios in the uterine and umbilical arteries nor the biophysical profile scores were altered significantly (P = .43, P = .23, Wilcoxon signed-rank median test, and P = .35, Fisher exact test, respectively). These findings suggest that the angiotensin sensitivity test does not increase resistance to flow in the uterine or umbilical circulation, and therefore may be used safely in screening for preeclampsia.

Adolescent↗
PubMed1989

Premature rupture of membranes prior to 34 weeks gestational age. One year experience at a tertiary center.

Records were reviewed of all patients with premature rupture of the membranes (PROM) at or less than 34 weeks estimated gestational age (EGA) who delivered at University Hospital of Jacksonville, Florida, during 1987. That year 132 patients were identified, 3.1% of all deliveries. The mean time from membrane rupture to delivery was three days, and the duration of PROM seven or more days in 9% of cases. Chorioamnionitis was diagnosed in 20% of the mothers. Delivery was by cesarean section in 30% of cases, twice the primary rate at University Hospital for 1987. Sixty-five percent of infants were male, and 13 males and four females of the 132 infants died before or after birth, the majority due to prematurity. Respiratory distress syndrome (RDS) was found in 35 infants and in 80% of these cases the membrane ruptured at 30 weeks or less. Intraventricular hemorrhage (IVH) was diagnosed in 8% of cases. Neonatal sepsis was a common diagnosis (41% of deliveries) with incidence being similar at all gestational ages. The length of membrane rupture was not statistically significant when compared with neonatal sepsis (P = 0.39).

Bacterial Infections↗
PubMed1989

Comparison of one dose cefazolin versus one dose cefotetan for cesarean section prophylaxis.

During one year, 646 women who delivered by cesarean section entered into a prospective randomized clinical trial to determine if a single intraoperative dose of cefazolin was as effective as cefotetan in the prevention of postoperative endomyometritis. Of 336 patients receiving 2 gm cefazolin intravenously at the time of clamping of the cord, endomyometritis developed in 30 (8.91%), and of 310 patients who received 2 gm cefotetan intravenously at the time of clamping of the cord, endomyometritis developed in 36 (11.6%). There was no statistically significant difference in the incidence of endomyometritis between the two groups (p = .269). We conclude that since the two drugs are equal in efficacy 2 gm of cefazolin is a cost effective method of prophylaxis for cesarean section.

Adolescent↗
PubMed1987

Effect of low-dose aspirin on angiotensin II pressor response in human pregnancy.

Recent clinical studies have reported a significant reduction in the incidence of pregnancy-induced hypertension after the ingestion of low-dose aspirin. The effect of 80 mg of acetylsalicylic acid on vascular sensitivity to exogenous angiotensin II (Hypertensin, Ciba-Geigy Limited, Basel, Switzerland) was examined in 13 normotensive pregnant patients. The effective pressor dose before treatment (17.4 +/- 2.2 ng/kg/min) (mean +/- SE) was significantly less (p less than 0.001) than that after treatment (35.1 +/- 4.2 ng/kg/min). Low-dose aspirin therapy resulted in an enhancement of the pregnancy-acquired refractoriness to angiotensin II. It can be speculated that prostaglandin synthetase inhibitors at a low dose may alter the thromboxane A2/prostacyclin ratio in favor of the latter.

Angiotensin II↗