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Biomedical subjects

H T MacKay

Publications and source records attributed to H T MacKay.

9 recordsLinked to original sources
PubMed1997

Sexually transmitted diseases and adverse outcomes of pregnancy.

We emphasize again that the prevalence of maternal infections may vary in different populations, and others might arrive at different estimates about the percentage of infants colonized and, concerning those infants colonized, about the percentage with adverse outcomes. Additionally, many women are colonized or infected simultaneously with several of the organisms discussed in this review, and this may result in different projections of morbidity and mortality rates than those presented here. We realize also that new information is generated continually describing the relationship between various maternal colonizations and preterm birth, and that screening and treatment protocols for several diseases may reduce the prevalence of adverse outcomes reported here. Therefore, we emphasize that the prevalences of various adverse pregnancy outcomes, as presented in this article, are only approximations and may change as new information becomes available. Nevertheless, we believe it is reasonable to estimate the relative effect of various maternal sexually transmitted diseases on adverse pregnancy outcome as we have done in this article. By comparing the effect of direct transmission of sexually transmitted organisms on adverse outcomes with the effect on overall outcome through an increase in the rate of preterm births, we should be able to use this type of analysis to establish some basis for allocation of resources to future research as well as intervention programs aimed at reducing sexually transmitted disease-related adverse outcomes of pregnancy. Finally, the appreciation of the effect of bacterial vaginosis on outcomes of pregnancy associated with preterm birth gives bacterial vaginosis a greater public health importance than has been attributed to it in the past as the subject of sexually transmitted disease research and prevention.

Female↗
PubMed1990

Ectopic pregnancy concurrent with induced abortion: incidence and mortality.

From 1972 through 1985, 24 women who underwent an induced abortion died as a result of a concurrent ectopic pregnancy. We analyzed data from the Joint Program for the Study of Abortion, National Hospital Discharge Survey, and the Centers for Disease Control Ectopic Pregnancy and Abortion Surveillance Systems to determine the incidence and mortality of ectopic pregnancy concurrent with induced abortion. During the period 1971 through 1985, the incidence of ectopic pregnancy concurrent with induced abortions was 1.35/1000 induced abortions, compared with 13.6/1000 pregnancies not terminated by induced or spontaneous abortion. The rate was higher among women who obtained abortions at earlier gestational age and among older women. The death-to-case rate for ectopic pregnancies concurrent with induced abortion was 1.3 times higher than that for women not undergoing abortion. Most of the deaths of women with ectopic pregnancy who underwent induced abortion were attributable to the failure to diagnose the ectopic pregnancy before the woman left the facility where the abortion was performed. Such deaths could be prevented by the provider of the abortion assuring that the tissue is examined for products of conception at the time of the abortion.

Abortion, Induced↗
PubMed1987

Legal abortion mortality in the United States: 1972 to 1982.

Between 1972 and 1982, 186 women died as a result of legal abortion in the United States. The overall death rate resulting from legal abortion dropped nearly fivefold, from 4.1 per 100,000 abortions in 1972 to 0.8 in 1982. Women who were older, black, of high parity, and had abortions at a later gestational age were at increased risk of death throughout the 11 years of surveillance. During this period, the death rate decreased for abortions at all stages of gestation; the greatest decrease was with abortions performed during the second trimester. For the entire interval, mortality rates were highest for abortions performed by hysterotomy or hysterectomy and lowest for abortions performed by curettage. Before 1977, the most common causes of abortion-related death were infection, hemorrhage, and general anesthesia complications, respectively. Thereafter, hemorrhage became the most common cause of abortion-related death, followed in number by general anesthesia complications. Our findings suggest that there has been a marked decrease in septic legal abortion deaths, but potentially preventable deaths from general anesthesia and hemorrhage remain an important concern. Use of general anesthetics during first-trimester abortions should be carefully reviewed.

Abortion, Legal↗
PubMed1985

Deaths from spontaneous abortion in the United States.

Little is known about maternal deaths after spontaneous abortion. We studied 122 such deaths reported to the Centers for Disease Control from 1972 through 1980; 21 were intrauterine (contraceptive) device related. The number of non-IUD-related deaths decreased from 15 in 1972 to six in 1980; the mortality ratio (deaths per million live births) decreased from 4.6 in 1972 to 1.7 in 1980. Non-IUD-related deaths were results of infection (48%), hemorrhage (21%), embolism (11%), and other causes (20%). Risk factors for these deaths were age over 29 years, being of minority race, and unmarried status. Most deaths (58%) occurred between 12 and 19 weeks' gestation. The risk of death was much higher for abortion in the second trimester than in the first. Deaths following spontaneous abortion, although rare, do occur; older, black, and unmarried women are at higher risk.

Abortion, Spontaneous↗
PubMed1985

Safety of local versus general anesthesia for second-trimester dilatation and evacuation abortion.

In 1980, approximately 100,000 women underwent abortion by dilatation and evacuation between 13 and 24 weeks' gestation; an estimated 500 women experienced serious complications. The comparative safety of local versus general anesthesia for second-trimester dilatation and evacuation is unknown. To compare the serious complications (hemorrhage requiring transfusion, unintended major surgery, and a temperature of greater than or equal to 38 C for greater than three days), 4147 women who received general anesthesia and 5389 women who received local anesthesia at 13 centers in the United States from 1975 to 1978 were studied. Women who had a dilatation and evacuation abortion under general anesthesia had a relative risk of serious complications of 2.6 (95% confidence interval 1.4 to 4.9) compared with women who underwent dilatation and evacuation abortion under local anesthesia. Local anesthesia for second-trimester dilatation and evacuation appears to be both safer and less expensive than general anesthesia.

Abortion, Induced↗
PubMedDate not supplied

Abortion training in obstetrics and gynecology residency programs in the United States, 1991-1992.

According to a 1991-1992 survey of program directors of obstetrics and gynecology residency programs in the United States, the overall percentage of programs providing any training in first-trimester (70%) or second-trimester abortion (66%) has changed very little since 1985. However, the proportion of programs providing routine training in first-trimester abortion decreased from 23% in 1985 to 12% in 1991-1992, and the proportion providing routine training in second-trimester abortion declined from 21% to 7%. The majority of the programs that dropped routine abortion training continued to offer optional training, but residents in programs with optional training were less likely to receive training. More than 80% of programs in private, non-Catholic hospitals and public hospitals provided some form of abortion training in 1991-1992, but only 6% of programs in Catholic hospitals and no military programs did so. In 45% of programs offering abortion training, residents performed one or fewer abortions per week.

Abortion, Induced↗