Browse Health
Obstetrician & Gynecologist (OB/GYN)
13 years of experience


Education ?

Medical School Score
Universidad Central Del Caribe (1999)

Publications & Research

Dr. Ramirez-Cacho has contributed to 3 publications.
Title Effect of a Specialized Prenatal Clinic on Medical Student Attitudes Toward Women with Drinking Problems.
Date July 2007
Journal The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

OBJECTIVE: To determine if student attendance at a specialized prenatal clinic would yield any change in their comfort level and in their attitudes toward pregnant women with drinking problems. METHODS: A total of 117 third-year students rotating consecutively on our core obstetrics-gynecology clerkship consented to enrolling in this prospective cohort study between February 2004 and June 2005. Each was assigned either to attend a half-day prenatal clinic designed specifically for women with alcohol and substance use disorders (study group) or not to attend the clinic (control group). The students answered anonymously a 15-question survey (using a 5-point Likert scale from 'strongly disagree' to 'strongly agree') at the beginning and at the midway point of the eight-week clerkship. Scores averaged for each question at the two points were compared within and between the two groups using paired-samples and independent-samples t-tests. RESULTS: No differences in responses to the survey were found between the study and control groups at the beginning of the clerkship. Students who attended the clinic became more comfortable in inquiring about patient alcohol consumption (p<0.001) and about social problems such as domestic violence (p<0.001). After attending the clinic, students reported that alcoholism was associated less with a weak will (p<0.01) and that group therapy has more importance (p<0.05). In contrast, the control group disagreed less that alcohol use was more of a moral and legal problem than a medical problem (p<0.05). CONCLUSIONS: An experience at this special prenatal clinic improved medical student awareness of complexities faced by problem drinkers, enhanced their comfort in talking to pregnant alcohol drinkers, and favored more sympathy toward alcoholism in general but not necessarily during pregnancy.

Title Medical Students' Attitudes Toward Pregnant Women with Substance Use Disorders.
Date March 2007
Journal American Journal of Obstetrics and Gynecology

OBJECTIVE: The objective of this study was to determine whether medical students' attendance at a clinic designed for pregnant substance users would yield changes in their attitudes toward the special needs of this population. STUDY DESIGN: This prospective study involved 104 consecutive third-year students rotating on our obstetrics-gynecology clerkship. Students were assigned to attend either a half day prenatal clinic designed specifically for women with substance use disorders during the first 4 weeks (study group) or during the second 4 weeks (control group). Each answered a confidential 24-question survey (using a 5-point scale from "strongly agree" to "strongly disagree"), dealing with comfort levels and attitudes, at the beginning and midway points of the 8-week clerkship. Student t tests were used for comparisons of averaged scores. RESULTS: At the beginning of the clerkship, no differences were found between the study (n = 52) and control groups (n = 52) in their responses to the survey. Regardless of gender, students who attended the clinic reported they became more comfortable in talking with patients about their substance use (P < .001) and more nonjudgmental in treating these patients (P < .02). Compared with before the clerkship, the control group became less comfortable in talking with these patients about their habits (P < .01), less aware about the prevalence of substance abuse during pregnancy (P < .02), and less aware about the efficacy of counselors (P < .05). CONCLUSION: Medical students became more comfortable and better informed about pregnant women with substance use disorders after attending a clinic dedicated toward this population's special needs.

Title Effect of Chronic Maternal Methadone Therapy on Intrapartum Fetal Heart Rate Patterns.
Date June 2006
Journal Journal of the Society for Gynecologic Investigation

OBJECTIVE: Treatment of maternal opioid dependence with methadone is associated with a delay in fetal heart rate (FHR) accelerations in nonstress tests. The objective of this investigation was to determine the effect of methadone maintenance therapy on intrapartum FHR patterns. METHODS: This retrospective cohort study compared intrapartum FHR tracings from 56 methadone-treated patients > or =36 weeks gestation with a control group of nonsubstance using patients matched for maternal age, parity, gestational age, and ethnicity. Blinded FHR interpretation included the recording of baseline, variability, accelerations, and late or severe variable decelerations. The 8-point FHR scoring system was based on the National Institute of Child Health and Human Development Research Planning Workshop guidelines. We considered a 25% reduction in the score during the latent phase to be significant. RESULTS: The median maintenance dose of methadone was 70 mg daily, with a range between 20 mg and 130 mg. Each patient tested negative for other substances on urine screening before admission. The significantly lower FHR score in the methadone group (mean difference, 1.4; 95% confidence interval, 1.1 to 1.7) was attributed to a lower baseline (P <.05), less moderate or marked variability (P <.01), and a lower proportion of accelerations during the first stage of labor (P <.01). A higher proportion of methadone-exposed fetuses had late or severe variable decelerations in the second stage (44.2% vs 22.9%; P <.03). Analgesic needs, operative vaginal or cesarean delivery rates, and Apgar scores less than 7 at 1 and 5 minutes were not significantly different between the two groups. CONCLUSIONS: Chronic maternal methadone treatment affects intrapartum FHR patterns by reducing the variability, baseline, and proportion of accelerations during the first stage. These subtle drug-induced effects do not compromise intrapartum decision-making or immediate newborn adjustments.

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