Biomedical subjects

W E Hawes

Publications and source records attributed to W E Hawes.

9 recordsLinked to original sources

PubMed1982

Fetal growth and perinatal viability in California.

To produce more appropriate information for evaluating fetal growth and viability, vital records data were used to compute percentile curves and perinatal, neonatal, and fetal mortality rates at specific birth weights and gestational ages. Percentile values were in good agreement with previous studies, and the large number of births (2,288,806) allowed for a more precise determination of fetal viability at various weight-age combinations than has been previously available. Mortality rates were found to be much more sensitive to birth weight than to gestational age, especially for small-for-gestational age fetuses. Optimal weight-age combinations were found to be up to 500 g and 2 weeks greater than the average combination. The results consistently emphasize the importance of rapid and sustained fetal growth at all gestational ages.

Birth Weight↗

PubMed1981

A study on the effects of induced abortion on subsequent pregnancy outcome.

Presented here is the pregnancy outcome of 2,081 women who had one or more previous induced abortions compared with the outcome of 4,098 matched control subjects without a history of abortion. Data were collected from records and interviews of women delivering spontaneously at nine California hospitals during a 16-month period, 1976 to 1978. Women with a history of previous induced abortion showed a small but statistically significant increase in incidence of subsequent pregnancy failure. The increased risk associated with previous abortion was substantially smaller than the increase associated with several other social, economic, and behavioral indicators measured at the same time.

Abortion, Induced↗

PubMed1981

Impact of a regional infant dispatch center on neonatal mortality.

In 1976, a regional Infant Medical Dispatch Center (IMDC) was implemented in Southern California to improve the lives and well-being of the critically ill newborn infants by expediting location of beds in neonatal intensive care units. Comparison of birth weight-specific neonatal mortality rates among 701-2000 grams neonates before and after the program showed a six-fold improvement in hospitals served by the Center over hospitals not served by the Center during the two-year period. From 1975 to 1977, a 43.7 per cent improvement in neonatal mortality among the 701-2000 grams neonates with hyaline membrane disease was observed in the transported infants served by the Infant Medical Dispatch Center as compared to a 22.9 per cent improvement in the group of transported infants not served by IMDC. Both indicators had consistently shown a marked improvement associated with the IMDC program beyond the improvement of medical sciences over the two years. The data suggest that the improved outcome of the neonates referred by IMDC might be related to the improved efficiency of locating available neonatal intensive care beds.

California↗

PubMed1979

Cesarean section, fetal monitoring, and perinatal mortality in California.

The rate of cesarean section in California has been growing at a compound rate of about 10 per cent per annum since 1969, coinciding with the advent of fetal monitoring. It is of interest, therefore, to study the distribution and efficacy of obstetric interventions. Information derived from the 1977 California birth cohort and a survey questionnaire was used to study the factors associated with the rate of cesarean section in 323 hospitals. Significant positive correlations were observed between the cesarean rate (CSR) and hospital factors indicative of a high degree of technology, including the proportion of labors electronically monitored. Significant negative correlations were observed between the CSR and hospital-specific variables suggestive of socioeconomically underprivileged patient populations. Other factors being constant, hospitals characterized by prepayment health care financing also had lower CSRs. A standaridized mortality ratio (SMR) based on 2.3 million births in the 1970--1976 cohorts was used to adjust the 1977 hospital specific perinatal mortality rates for birth weight, gestational age, sex, race, and plurality. The results show that hospitals which intervene technologically in a large proportion of births have lower risk adjusted perinatal mortality rates.

Adolescent↗

PubMed1977

Outcomes of elective home births: a series of 1,146 cases.

Medical records of 1,146 elective home births from five home delivery services in northern California were reviewed. Three of the services consisted of family physicians and nurses, whereas two consisted of lay midwives without immediate physician supervision. Rates of medical complications in both groups were low. Perinatal morbidity and mortality were lower than California averages. Fifteen premature infants (1.3%) were delivered successfully. Apgar scores were high. Four infants (0.3%) were neurologically abnormal at follow-up. The perinatal mortality rate was 9.5 per 1,000 total births. There were no maternal deaths. These figures demonstrate that in a self-selected, medically screened, low-risk population, home delivery with medical facility back-up can be a reasonable alternative to hospital delivery. Possible reasons for the good results obtained are cited.

Adult↗

PubMed1976

High risk perinatal care in California.

Rates of perinatal mortality are still too high in California. Mortality and morbidity, particularly for high risk pregnancies, can be reduced by the use of modern technology in the hands of highly trained personnel. New goals for perinatal care have been published by the California Medical Association reflecting these changes. This kind of care is too costly to be developed in all the small obstetric units presently providing services in California. Consolidation of obstetric and neonatal units into fewer hospitals can make it economically possible for these units to meet present-day standards.

California↗

PubMed1976

Legislation relevant to perinatal care.

The legislative process is one route to follow in the attempt to change and improve perinatal care. Payment by the State Crippled Children's Service for medical care of certain costly high-risk neonatal conditions, only to qualified specialists and in centers meeting acceptable standards has had a snowball effect on upgrading neonatal care in this state. Not only has a large network of neonatal care centers and infant transport systems been developed, but there has been a rush especially on the part of nurses, to get special training in neonatal care. This has included not only the care of the sick neonate, but a look at newborn evaluation and resuscitation in the delivery and newborn areas. It is expected that this same center development and education and training process will now be extended to obstetrical care, as there is renewed interest in special care for high-risk mothers because of Assembly Bill 1326. The new hospital perinatal regulations mandate improvement of care in community hospitals where the majority of deliveries take place. The emphasis is on a larger and better educated staff, more concern with patients rights, and provision of a more humanistic family centered care as well as continual evaluation of maternal and neonatal outcome. The greatest limitation has been lack of Health Department staff to provide adequate consultation and surveillance of these services for compliance with the new laws. There has been an approximate 10 per cent reduction in the number of hospitals with maternity services- from 416 in 1968 to 369 today. While much of this consolidation may have been due to the fall in birth rate, these regulations have also contributed to the process. Most important of all, these laws have kept perinatal care constantly in the consciousness of California health care providers and consumers.

California↗

PubMed1975

A survey of newborn intensive care centers in California.

Newborn intensive care has come of age in California. Twenty-one newborn intensive care centers and 11 community level units are now approved by Crippled Children Services in California. In 1973 there were more than 6,863 patients admitted to the 20 centers surveyed, over half requiring transport from referring hospitals. This paper provides information on the distribution, admission and occupancy rates, length of stay, costs and admission diagnoses for these high risk infants.

California↗

PubMed1973

Two years' experience with Rh hemolytic disease reporting.

California law, since January 1 1970, has required that all pregnant women, regardless of outcome of delivery, be tested for Rho(D) type, that the mother and physician be notified of the result and that hospitals providing service to newborns report all cases of Rho(D) Hemolytic Disease to the State Department of Public Health. Although there has been only a gradual decrease in the number of deaths due to Rho(D) Hemolytic Disease of the Newborn since 1950, there has been a precipitous fall in the past two years. Since the commencement of reporting of the disease to the State Health Department the number of cases has also dropped dramatically. It is felt that because of our conscientiously administered reporting law the morbidity and mortality figures from HDN in California are accurate, in contrast to results obtained in most other states. It is believed that this report reflects the first really accurate look at a large population for the incidence and mortality from Rho(D) HDN since the advent of widespread use of anti-Rho(D) gamma globulin. Review of the recent literature failed to reveal definitive data on recent incidence and mortality trends for Rho(D) HDN. A survey of state health departments also failed to produce data comparable with California's.A number of factors have played a part in reducing the incidence and mortality from Rho(D) HDN in California-namely, required testing of pregnant women combined with the almost routine use of of anti-Rho(D) immune globulin in eligible women, early recognition and treatment of Rho(D) HDN, and the reduction in family size with an increasing percentage of primiparous mothers.

California↗