Publications by authors named "H Ramnarain"

3 Publications

  • Page 1 of 1

Prosthetic heart valve thrombosis in pregnancy: a case series on acute management.

Cardiovasc J Afr 2021 May 4;32:1-4. Epub 2021 May 4.

Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.

Rheumatic heart disease is one of the leading causes of valve dysfunction, resulting in prosthetic valve implantation. Changes in physiology and the haemodynamics of pregnancy increase the susceptibility of thrombosis to the prosthetic valve in the pregnant woman. Valve redo surgery carries a considerable risk of maternal and perinatal morbidity and mortality. Women of reproductive age should be well counselled regarding compliance with anticoagulation, contraception and pre-pregnancy planning.
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http://dx.doi.org/10.5830/CVJA-2021-013DOI Listing
May 2021

Patients attitudes to vaginal examination and use of chaperones at a public hospital in South Africa.

Niger J Clin Pract 2016 Jan-Feb;19(1):110-4

Department of Obstetrics and Gynaecology, King Edward Hospital, University of KwaZulu-Natal, Durban, South Africa.

Background: Obstetrics and gynecology units in public hospitals in South Africa (SA) are often overloaded with patients. Most physical examinations/consultations in these units involve vaginal examination (VE) and often because of the rapid turnover of patients the pelvic examination may be performed hurriedly without due consideration being given to the psychosocial aspects of such procedures.

Objective: This study surveyed the attitudes of patients to VE and the use of chaperones.

Methods: A descriptive cross-sectional survey of patients attending obstetrics and gynecology clinics at a public hospital in SA was carried out. A structured questionnaire was used to collect sociodemographic data such as age, ethnic group, gravidity, feelings toward VE, and preferences about the gender of the examining doctor, as well as the presence of a chaperone.

Results: Most women (68%) were aged between 20 and 35 years. The respondents stated that the most intimate examination was VE in 48.3% and abdominal in 25% of cases; 19.0% and 1.5% of respondents felt that breast and rectal examinations, respectively, was the most intimate. On the response to the statement "there is no need for chaperone during VE;" 54% of the participants were in support of chaperone while 45.1% were against chaperone. Women aged 20-35 years, preferred a nurse as their chaperone; younger women, aged ≤19 years preferred their mother as a chaperone.

Conclusion: In an SA public hospital, women are more likely to regard VE as the most intimate examination. Women are equivocal on the use of a chaperone and if it was necessary; nurses are their preferred choice except for teenagers, who preferred their mothers.
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http://dx.doi.org/10.4103/1119-3077.173713DOI Listing
December 2017

An audit of pregnant women with prosthetic heart valves at a tertiary hospital in South Africa: a five-year experience.

Cardiovasc J Afr 2012 May;23(4):216-21

Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.

Background: Cardiac disease in pregnancy is a common problem in under-resourced countries and a significant cause of maternal morbidity and mortality. A large proportion of patients with cardiac disease have prosthetic mechanical heart valve replacements, warranting prophylactic anticoagulation.

Aim: To evaluate obstetric outcomes in women with prosthetic heart valves in an under-resourced country.

Methods: A retrospective chart review was performed of 61 pregnant patients with prosthetic valve prostheses referred to our tertiary hospital over a five-year period.

Results: Sixty-one (6%) of 1 021 pregnant women with A diagnosis of cardiac disease had prosthetic heart valves. Fifty-nine had mechanical valves and were on prophylactic anticoagulation therapy, three had stopped their medication prior to pregnancy and two had bioprosthetic valves. There were forty-one (67%) live births, two (3%) early neonatal deaths, 12 (20%) miscarriages and six (10%) stillbirths. Maternal complications included mitral valve thrombosis (n = 4), atrial fibrillation (n = 8), infective endocarditis (n = 6), caesarean section wound haematomas (n = 7), broad ligament haematoma (n = 1) and warfarin embryopathy (n = 4). Haemorrhagic complications occurred in five patients and all five required blood transfusions.

Conclusion: Prophylactic anticoagulation with warfarin in patients with mechanical heart valve prostheses was associated with high rates of maternal and neonatal complications, including significant foetal wastage in the first and early second trimesters of pregnancy. Health professionals providing care for pregnant women with prosthetic heart valves must consistently advise on family planning matters, adherence to anticoagulation regimes and consider the use of prophylactic anticoagulant regimens other than warfarin, particularly during the first trimester of pregnancy.
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http://dx.doi.org/10.5830/CVJA-2012-022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721885PMC
May 2012
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