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Biomedical subjects

S F Dorfman

Publications and source records attributed to S F Dorfman.

15 recordsLinked to original sources
PubMed1995

Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991.

OBJECTIVES: We attempted to document the role of homicide and other injuries as causes of maternal death and to compare the risk of fatal injury among pregnant women with that in the general population. STUDY DESIGN: We reviewed New York City medical examiner records of 2331 women aged 15 to 44 years who died of injury in 1987 through 1991. Pregnancies were identified from autopsy information. RESULTS: A total of 115 (39%) of 293 deaths in currently or recently pregnant women were attributable to injury. These 115 deaths included homicide (63%), suicide (13%), motor vehicle crashes (12%), and drug overdoses (7%). Minority women were overrepresented among the injury deaths (black 53%, Hispanic 24%, white 19%). Recent substance use was documented in 48% of the injury deaths. Pregnancy was documented on only 35% of the 115 death certificates. The risk of fatal injury is similar for currently pregnant women and for women in the general population, except for an increased risk of homicide among pregnant black women. CONCLUSIONS: Homicide and other injuries are major contributors to maternal mortality and should be (but rarely are) included routinely in maternal mortality surveillance systems. Prenatal and postpartum clinic visits represent an ideal time to implement interventions to prevent injuries among pregnant women.

Accidents, Traffic↗
PubMed1990

Maternal mortality in New York City, 1981-1983.

The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. Fifty-seven deaths were associated with cesarean delivery, although most of these could not be attributed to the mode of delivery. Sixty-six (55%) of the deaths were classified as direct maternal deaths. The age ranged from 16-44 years, with 83 (69%) of the women aged 20-34, 11 (9%) 19 or less, and 26 (22%) aged 35 or older. Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.

Adolescent↗
PubMed1984

Ectopic pregnancy. 'Thinking ectopic,' key to diagnosis.

During the past decade, the number of ectopic pregnancies in the United States nearly tripled. Although maternal mortality from this cause declined over the same period, the rate could be further reduced with earlier diagnosis and treatment. After a pregnancy has been confirmed by urine or blood testing, its location, if questionable, should be determined by sonography. The possibility of ectopic pregnancy should be considered not only for patients at high risk but also for those whose signs and symptoms differ from textbook descriptions of ectopic pregnancy. Definitive treatment is surgical, with the choice of technique determined in part by the patient's feelings about future fertility.

Diagnosis, Differential↗
PubMed1984

Ectopic pregnancy mortality, United States, 1979 to 1980: clinical aspects.

Ectopic pregnancy has recently become a major cause of maternal mortality in the United States. Despite its increasing public health impact, relatively little is known about the clinical epidemiology of this condition. Therefore, the authors investigated all reported deaths from ectopic pregnancy in the United States occurring in 1979 and 1980, to determine characteristics of, and risk factors for, fatal ectopic pregnancy. Most women (85%) died from hemorrhage. Abdominal and interstitial implantations were more likely to become symptomatic later in gestation and to be fatal than were tubal implantations. Of those deaths for which circumstances were known, more prompt diagnosis and treatment of ectopic pregnancy by health professionals might have prevented one-half of the deaths. One-third of the deaths might have been prevented if the women had notified or visited a physician more promptly after the onset of symptoms. Timelier action by women and health professionals could reduce ectopic pregnancy mortality.

Adult↗
PubMed1983

Ectopic pregnancy in the United States 1970 through 1978.

Trends of the incidence and mortality associated with ectopic pregnancy (EP) in the United States were examined for 1970 through 1978. The estimated number of EPs rose from 17,800 in 1970 to 42,400 in 1978, and the EP incidence rate rose from 4.5 per 1,000 reported pregnancies to 9.4 during the same time period. The risk of EP was higher for older women and nonwhite women. Over 2.5% of all reported pregnancies among nonwhite women aged 35 to 44 years were ectopic. The death-to-case rate for EP declined almost 75% during the study period but remained consistently higher for nonwhite women as compared with white women.

Abortion, Induced↗
PubMed1983

Deaths from ectopic pregnancy, United States, 1979 to 1980.

During the 1970s in the United States, the number of hospitalizations for ectopic pregnancy increased more than twofold, and ectopic pregnancy emerged as a leading cause of maternal mortality. All known deaths from ectopic pregnancy in the United States from January 1, 1979, to December 31, 1980, were investigated by the Centers for Disease Control to determine incidence, characteristics, and risk factors for fatal ectopic pregnancy. Deaths were reported primarily by state health departments; numbers and characteristics of women who had ectopic pregnancies were obtained through the National Hospital Discharge Survey of the National Center for Health Statistics. Eighty-six deaths were confirmed among an estimated 102,100 cases of ectopic pregnancy, for an overall death-to-case rate of 0.8 per 1000. Women of black and other races had a relative risk of death 3.2 times that of white and Hispanic women. Continued surveillance should help to reduce the number of deaths through the education of women and health professionals.

Adolescent↗
PubMed1983

Use of quinine for self-induced abortion.

We present four recent cases in which quinine was used for self-induced abortion. Abortion was achieved in only one of these cases. Literature review suggests that quinine is an ineffective abortifacient, even when taken in toxic doses. Adverse effects of quinine include cinchonism, potentially fatal renal failure, and possible teratogenesis. Quinine is available over-the-counter, but it has few legitimate medical indications. Health care personnel treating women with undesired pregnancies should be alert to the signs and symptoms of quinine toxicity.

Abortifacient Agents↗
PubMed1983

Maternal deaths associated with antepartum fetal death in utero, United States, 1972 to 1978.

Little is known about the overall incidence of fetal death in utero (FDIU) in the United States or about the risks associated with its management. To address these questions, this study provides nationwide incidence data and reviews nine deaths of women with FDIU in the United States from 1972 to 1978. The crude death-to-case rate associated with FDIU is at least 4.5 deaths per 100,000 cases (95% confidence limits, 2.1 to 8.5). Existing information from comparative studies is inadequate to evaluate the comparative safety of different methods of evacuating the uterus after FDIU occurs at different gestational ages. Management of such cases should be determined by both the experience of the physician with uterine evacuation techniques and the medical and psychologic needs of the woman.

Abortion, Missed↗