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Biomedical subjects

W Cates

Publications and source records attributed to W Cates.

At least 91 records · Page 5Linked to original sources
PubMed1984

Hysterectomy as treatment for complications of legal abortion.

The frequency of hysterectomy as treatment for abortion complications may reflect the incidence of serious abortion morbidity. To examine this use of hysterectomy, the authors analyzed reports of approximately 237,000 legal abortions performed in the United States from 1970 to 1978. Overall, the rate of hysterectomy associated with curettage abortion decreased from 4.6 per 10,000 abortions in 1970 to 1971 to 1.4 per 10,000 in 1975 to 1978; the rate of hysterectomy associated with instillation abortion fell from 6.8 to 4.3 per 10,000 for the same years. A history of older age, previous births, use of instillation abortion, and preexisting gynecologic disorders increased the likelihood of hysterectomy. In cases of curettage abortion, hysterectomy rates increased significantly with advancing gestational age. Changes in abortion technology, improvements in physician skill, and more conservative management of complications have likely contributed to the decreasing frequency of hysterectomy necessitated by abortion complications.

Abortion, Legal↗
PubMed1983

The risks associated with teenage abortion.

the risks of morbidity and mortality affect a teenager's choice between termination of a pregnancy through induced abortion and continuation of the pregnancy. To identify these risks, we analyzed information from two separate sets of data collected by the Centers for Disease Control: that of the Joint Program for the Study of Abortion, a multicenter prospective study of nearly 165,000 legally induced abortions; and that of a national surveillance of abortion-related mortality. The rates of major complications associated with abortions in teenagers were 1 to 3 per 1000 suction-curettage procedures and approximately 13 per 1000 saline-administration procedures. The death-to-case rate for teenage women was 1.3 per 100,000 procedures. When the data on procedures were adjusted according to gestational age, teenagers generally had lower rates of morbidity and mortality from induced abortion than older women.

Abortion, Induced↗
PubMed1983

Urea-prostaglandin versus hypertonic saline for instillation abortion.

Authorities have suggested use of a combination of hyperosmolar urea and low-dose prostaglandin F2 alpha as a second-trimester intra-amniotic abortifacient to avoid the disadvantages of hypertonic saline solution. To examine the safety and efficacy of urea-prostaglandin compared with the instillation of saline solution, we analyzed data from a prospective multicenter study conducted in the United States between 1975 and 1978. Both agents were highly effective in producing an abortion. However, urea-prostaglandin had a significantly lower rate of serious complications when compared with saline solution (1.03 versus 2.18 per 100 abortions; p less than 0.001). Urea-prostaglandin also had a significantly shorter induction-to-abortion time (14.2 versus 25.6 hours; p less than 0.001). Urea-prostaglandin, therefore, appears to be superior to hypertonic saline solution as an abortifacient.

Abortifacient Agents↗
PubMed1983

Measures to prevent cervical injury during suction curettage abortion.

Cervical injury is one of the most frequent complications of suction curettage abortion, yet little is known about its risk factors or prevention. In 15 438 suction curettage abortions carried out at less than or equal to 12 weeks' gestation in hospitals in the USA from 1975 to 1978 the incidence of cervical injury requiring suturing was 1.03 per 100 abortions. Among factors potentially within the physician's control, use of laminaria rather than rigid dilators for dilatation had a strong protective effect (relative risk 0.19), whereas performance of the abortion by a resident rather than an attending physician (relative risk 2.0) and use of general rather than local anaesthesia (relative risk 2.6) had detrimental effects on rates of cervical injury. Among other factors, a previous abortion had a protective effect (relative risk 0.46), whereas patient age less than or equal to 17 years had a detrimental effect (relative risk 1.9). Use of laminaria, performance of the abortion by an attending physician, and local anaesthesia together yield a 27-fold protective effect.

Abortion, Induced↗
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

Women refused second-trimester abortion: correlates of pregnancy outcome.

Little is known of the outcome of pregnancy in women denied abortions in the United States. To address this question, we studied the pregnancy outcomes in 316 low-income women who were denied second-trimester abortion at a large, metropolitan teaching hospital in the Southeast between August, 1978, and July, 1979. Follow-up information was available on 82%. One in five women denied an abortion managed to obtain one elsewhere. Earlier gestational age at the initial abortion request, higher education level, and higher income were the best predictors of whether a woman subsequently obtained an abortion. For the women who continued their pregnancies, neither the rate of serious maternal complications nor the neonatal death rate was increased when compared with that of the rest of the hospital's population.

Abortion, Induced↗
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↗
PubMed1982

Dilatation and evacuation procedures and second-trimester abortions. The role of physician skill and hospital setting.

Some clinicians have hesitated to perform dilatation and evacuation (D & E) procedures at 13 weeks' gestation or later because D & Es are more difficult to perform safely than suction-curettage procedures. Moreover, many clinicians still believe all second-trimester abortion procedures should be performed in a hospital. To evaluate these concerns, we analyzed 24,664 abortion performed between 1973 and 1978 by four physicians associated with a large outpatient abortion facility; 3,711 (15%) of the abortions were second-trimester procedures. Dilatation and evacuation was associated with a lower rate of serious complications per 100 procedures (0.23) than instillation of either dinoprost (prostaglandin F2 alpha) (1.28) or hypertonic saline (2.26). In addition, D & E had lower rates for most other specific complications. We conclude that D & E, while requiring more operator skill than earlier suction-curettage procedures, can be learned by gynecologists familiar with suction-curettage, can be performed more safely than the alternative instillation procedures, and can be safely practiced in selected ambulatory settings.

Abortion, Induced↗
PubMed1982

Mortality from abortion and childbirth. Are the populations comparable?

Critics have challenged previous comparisons of mortality from legal abortion and childbirth for contrasting population groups with different clinical characteristics. They allege that most women dying from abortion were young, white, and healthy, while those dying from childbirth had serious underlying conditions. To address this question, we calculated standardized abortion and childbirth mortality rates between 1972 and 1978. We also adjusted independently for preexisting medical conditions. These adjustments for demographic and health differences between the two populations actually widened the difference in the mortality risk between abortion and childbirth. Thus, between 1972 and 1978, women were about seven times more likely to die from childbirth than from legal abortion, with the gap increasing in the more recent years.

Abortion, Legal↗
PubMed1982

Mortality from abortion and childbirth. Are the statistics biased?

Critics have challenged previous comparisons of mortality from legal abortion and childbirth for containing biases in the crude data that spuriously favor the safety of abortion. To evaluate this concern, we reviewed the sources of mortality data on which these comparisons are based and examined the completeness of abortion mortality statistics, the completeness of childbirth mortality statistics, and the accuracy of the denominators for both these events. We found the evidence to be consistent in two directions: (1) abortion deaths appear to be more completely ascertained than childbirth deaths; (2) use of different denominator estimates has relatively little impact on the comparison. From this evidence, we conclude that the crude data are biased in a direction that overestimates the abortion risks for the women relative to the risks of childbearing.

Abortion, Legal↗
PubMed1982

Legal abortion: the public health record.

The increasing availability and utilization of legal abortion in the United States has several important effects on public health in the 1970's. It reduced deaths and surgical complications among women of childbearing age; it made possible the development of safer surgical procedures for pregnancy termination; and it increased the provision of low-cost outpatient gynecologic services. There is some concern about potential adverse outcomes in future desired pregnancies and possibly higher risks of breast cancer in certain women.

Abortion, Legal↗
PubMed1982

The risk of death from combined abortion-sterilization procedures: can hysterotomy or hysterectomy be justified?

Clinicians have debated whether women who request permanent sterilization when they undergo elective abortion should have the two operations done concurrently. Moreover, if the procedures are performed concurrently, the appropriate surgical approach is unknown. To evaluate the latter issue, we identified all concurrent abortion-sterilization deaths in the United States in the period 1972 to 1978 from the Centers for Disease Control's nationwide surveillance of abortion mortality and divided them into two groups: those who had hysterotomy with tubal ligation or hysterectomy (H/H) and those who had curettage or instillation procedures, with tubal ligation by laparoscopy or laparotomy (other procedures). We then used data from the Joint Program for the Study of Abortion (JPSA/CDC) to estimate the number of procedures done in the United States in the period 1972 to 1978 and calculated death-to-case rates for each group. We found that the risk of dying from a concurrent abortion-sterilization procedure was 3.3 times higher if done by H/H. The relative risk for this group was highest during the first 12 weeks of gestation (4.6) and lowest at 13 weeks or later (1.3), regardless of the presence or absence of preexisting medical conditions. Except in the rare instances where the woman has an indication for hysterectomy other than fertility control, the performance of hysterectomy or hysterectomy for concurrent abortion-sterilization, particularly at less than 13 weeks' gestation, does not appear justified.

Abortion, Therapeutic↗