Pregnancy-related mortality in New York City, 1980 to 1984: causes of death and associated risk factors

Article Abstract:

Although the number of pregnancy-related deaths per 100,000 live births (the pregnancy-related mortality ratio) declined between 1915 and 1984, the rate of decline slowed appreciably after 1980. The US pregnancy-related mortality ratio is estimated to be between 10.8 and 16.5 deaths per 100,000 live births. Minority women are known to be at increased risk for death related to pregnancy when compared with whites. Women over 30 years old also are at higher risk. To learn more concerning the causes of pregnancy-related death in New York City between 1980 and 1984, a study of vital statistics was carried out. Deaths were classified as directly (from a condition of pregnancy or delivery) or indirectly (when pregnancy exacerbated an existing medical condition) related to pregnancy, or were due to other causes (homicide, drug overdose). Risk factors such as age, marital status, education, previous live births, prenatal care, and ability to pay for health services were evaluated. Results showed that the overall pregnancy-related mortality ratio for the years studied was 40.2 deaths per 100,000 live births. Almost three-quarters of these deaths were directly related to pregnancy. The most frequent causes included ectopic pregnancy (pregnancy in a site other than the uterus); pulmonary emboli (blood clots that block blood circulation to the lungs); high blood pressure; and cardiac arrest. Common indirect causes included nonobstetric infections and complications of cardiovascular conditions. Women who were between 20 and 24, non-Hispanic white, married, educated beyond high school, privately insured, having their first child, and having more than five prenatal visits, had the lowest risk of pregnancy-related death. Those who were 40 or older, black, unmarried, educated between 9 and 11 years, uninsured even by Medicaid, had five or more previous live births, and little or no prenatal care, were at highest risk. It appears that women in New York City suffer a large number of pregnancy-related deaths that could be prevented by improved access to medical care. Prenatal care could also mitigate the effects of factors such as age and lack of education. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mortality, Patient outcomes, Causes of, Statistics, Pregnant women, New York, New York, New York

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A chill wind blows: Webster, obstetrics, and the health of women

Article Abstract:

The Supreme Court decision in Webster versus Reproductive Health Services permits states to regulate abortion as desired, with the exception that they cannot prohibit abortion within the first 24 weeks of gestation. However, the restrictions states may place on the abortion procedure may effectively prevent some women from having abortions. The state of Missouri prohibits the use of public funds, facilities, and personnel for the performance of abortion even if paid for by the patient, and also enforces inappropriate viability testing requirements. For example, the analysis of amniotic fluid (which surrounds the fetus) to determine the maturity of the fetal lungs is not reliable until 30 weeks of gestation or later, and it should not be used until that time. Furthermore, the court refuses to make a decision concerning the Missouri abortion law that declares that life begins at conception and defines conception as fertilization. This law concerning conception and embryonic and fetal status would make antenatal tests or screening methods before birth inappropriate; interfere with research in reproductive medicine, such as that concerning in vitro fertilization; and jeopardize medical training in obstetrics and gynecology. If obstetrics and gynecology residents are not permitted to become familiar with the procedure of abortion, the incidence of complications from abortion will again increase. In previous decisions, the Supreme Court has declared that the mother's health cannot be sacrificed on behalf of the fetus. Currently, abortions in the first and second trimester have a lower risk of maternal death than childbirth. The women most likely to be endangered by the restrictions of the Missouri state abortion laws are the poor. Restricted access to legal abortion may result in an increase in infant deaths due to unwanted and high-risk pregnancies. Finally, the inability of a physician to counsel patients or advise termination of pregnancy interferes with the relationship between physician and patient and threatens the patient's rights of confidentiality and informed consent. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Laws, regulations and rules, Missouri, Medical law

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Women's reproductive health

Article Abstract:

Historically US abortion law was based on British common law which placed no restrictions on abortion until after quickening, or fetal movement, occurred. Physicians were among the original activists working for the criminalization of abortion during the 1800s. Laws spread until it was illegal throughout the US by 1900. They remained in place until 1973 when four states legalized abortion and 15 others relaxed regulations against it. Also in 1973, the Supreme Court established a woman's right to an abortion during the first two trimesters of pregnancy in Roe v. Wade. Later restrictions include the Hyde Amendment, which was passed by Congress in 1976, and prohibits the use of federal funds for abortions. The Supreme Court has also decided in other cases that states may restrict access to abortions as long as the restrictions do not constitute an undue burden for the woman seeking the service. Obstetric and gynecological residency programs should ensure that women continue to have access to safe, legal abortions by making abortion procedures a routine part of training.

History

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