Biomedical subjects

M K Ramadan

Publications and source records attributed to M K Ramadan.

4 recordsLinked to original sources

PubMed1995

Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis.

OBJECTIVE: Our purpose was to describe subsequent pregnancy outcome and long-term maternal prognosis in women with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) during the index pregnancy. STUDY DESIGN: This is a descriptive and analytic study of women with HELLP syndrome admitted to E.H. Crump Women's Hospital between August 1977 and July 1992. HELLP syndrome was defined by previously published laboratory criteria. Only patients who were delivered > 2 years ago were included (median 4 years, range 2 to 14 years). Data on these patients were obtained from our obstetric clinics, local physicians, local health departments, and hospital records. RESULTS: Adequate follow-up data were available on 341 patients. One hundred fifty-two women subsequently became pregnant. One hundred thirty-nine normotensive women had 192 subsequent pregnancies. Complications included preeclampsia (19%), preterm delivery (21%), intrauterine growth restriction (12%), abruptio placentae (2%), perinatal death (4%), and HELLP syndrome (3%). Seven of the 113 women with at least 5 years' follow-up (6.2%) had chronic hypertension, and 98 received oral contraceptive pills without complications. Thirteen women with preexisting chronic hypertension had 20 subsequent pregnancies. These women had a higher rate of preeclampsia (75%), preterm delivery (80%), intrauterine growth restriction (45%), abruptio placentae (20%), and perinatal death (40%) but a low rate of recurrent HELLP syndrome (5%). CONCLUSIONS: Women with HELLP syndrome have an increased risk of obstetric complications in future pregnancies but a low risk for recurrent HELLP syndrome. Oral contraceptive pills should not be contraindicated in normotensive women.

Adult↗

PubMed1994

Late postpartum eclampsia revisited.

OBJECTIVE: To describe the clinical and neurologic findings in patients with late postpartum eclampsia (convulsions beginning more than 48 hours, but less than 4 weeks, after delivery). METHODS: This study evaluated all patients with the diagnosis of late postpartum eclampsia managed at our institution between August 1977 and July 1992. RESULTS: There were 54 cases of late postpartum eclampsia among a total of 334 cases of eclampsia during the study period. Late postpartum eclampsia constituted 56% of total postpartum eclampsia and 16% of all cases of eclampsia. Convulsions began from postpartum days 3-23 (mean 6). Thirty women (56%) had been identified as preeclamptic before their convulsions. A history of either severe headache or visual disturbances before convulsion was elicited in 83% of the patients. During the study period, eight women not included in the study group had late postpartum seizures attributed to other causes. CONCLUSIONS: Severe headache or visual disturbance frequently antedates late postpartum eclampsia. Only eight of 62 patients with late postpartum seizures had identifiable etiologies other than eclampsia.

Adult↗

PubMed1993

Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome)

OBJECTIVE: Our purpose was to describe the incidence and effects of serious obstetric complications on maternal outcome in pregnancies complicated by HELLP syndrome. STUDY DESIGN: A prospective cohort study was performed on 442 pregnancies with HELLP syndrome managed at this center from August 1977 through July 1992. RESULTS: Of 437 women who had 442 pregnancies with HELLP syndrome; 309 (70%) of the cases occurred ante partum and 133 (30%) post partum; 149 (11%) developed at < 27 weeks and 80 (18%) at term. Maternal mortality was 1.1% (five patients). Serious maternal morbidity included disseminated intravascular coagulation (21%), abruptio placentae (16%), acute renal failure (7.7%), pulmonary edema (6%), subcapsular liver hematoma (0.9%), and retinal detachment (0.9%). Fifty-five percent of patients required transfusions with blood or blood products, and 2% required laparotomies for major intraabdominal bleeding. Abruptio placentae was strongly correlated with the development of disseminated intravascular coagulation (p < 0.0001), acute renal failure (p < 0.001), and pulmonary edema (p < 0.01). Moreover, there was a strong association between pulmonary edema and acute renal failure (p < 0.0001). There were no differences in laboratory findings between HELLP syndrome before and after delivery; however, women with postpartum HELLP syndrome had significantly higher incidences of pulmonary edema and renal failure. CONCLUSION: HELLP syndrome is associated with serious maternal morbidity, especially when it arises in the postpartum period.

Abruptio Placentae↗

PubMed1993

Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets.

OBJECTIVE: Our purpose was to describe maternal-perinatal outcome, subsequent pregnancy outcome, and long-term prognosis after hemolysis, elevated liver enzymes, and low platelets and acute renal failure. STUDY DESIGN: Thirty-two patients with this complication were studied in the index pregnancy and were subsequently followed for an average of 4.5 years. Six patients had preexisting hypertension, and 26 were normotensive during the index pregnancy. RESULTS: There were four maternal deaths (13%), 27 (84%) had disseminated intravascular coagulation, 14 (44%) had pulmonary edema, and 10 (31%) required dialysis. The perinatal mortality rate was 34%, and 72% of births were preterm. Eight normotensive women had 11 subsequent pregnancies, only one complicated by preeclampsia. Four hypertensive women had six subsequent pregnancies; three were complicated by severe preeclampsia and fetal death (one complicated by hemolysis, elevated liver enzymes, and low platelets and one by renal failure). None of 23 surviving normotensive women had residual renal damage or hypertension on follow-up, whereas two of five hypertensive women required chronic dialysis. CONCLUSION: These findings should be used in counseling these patients regarding the index pregnancy and future pregnancies.

Acute Kidney Injury↗