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Abruptio placenta.

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Abruptio Placentae↗

Severe medical illness complicating cesarean section.

The care of the perioperative cesarean birth patient who has serious medical illnesses has changed in the past decade. The increasing sophistication of monitoring has allowed the obstetrician and anesthesiologist better to modify certain physiologic parameters that are important in the care of the patient whose physiology has been altered by surgery or disease. As an increasing segment of the obstetric population becomes older, and with better survival of medical diseases, the profession as a whole will be challenged by these patients. It will become more important that a certain subset of physicians develop the skills necessary to undertake the care of these patients and that the special needs of these patients be recognized.

Acute Kidney Injury↗

Reproductive mortality in Lusaka, Zambia, 1982-1983.

In this study, age- and parity-specific birth data were used to estimate maternal mortality rates for 1982-83 at University Teaching Hospital in Lusaka, Zambia. Overall, 60 maternal deaths occurred during pregnancy or within 42 days after pregnancy termination, and four pregnancy-related deaths occurred more than 42 days after pregnancy termination. Nine of the 60 maternal deaths were caused by induced abortion, one by spontaneous abortion, twelve by hypertensive disease of pregnancy, ten by hemorrhage, nine by puerperal sepsis, and four by ectopic pregnancy. Of the 12 women who died from nonobstetric causes, one committed suicide because of an unwanted pregnancy. Women aged 35 years and older or who had had four previous pregnancies had a higher risk of dying than other women, especially by hemorrhage. The chief risk factors included not using an effective method of contraception, using an unsafe means to terminate unintended pregnancies, lack of prenatal care, refusing a blood transfusion (for religious reasons), and inadequately treating hypertensive disease of pregnancy. Overall, 31 of 60 women who died lacked adequate or appropriate medical care and 19 failed to obtain available health care. Medical management problems appeared to occur more frequently during the night-time medical shift.

Abortion, Induced↗

Morbidity and mortality from second-trimester abortions.

The comparative safety of methods used to perform second-trimester abortion is an important public health concern. Morbidity and mortality studies have indicated that dilation and evacuation (D&E) is safer than instillation abortion, which is safer than hysterotomy and hysterectomy. In the third phase of the Joint Program for the Study of Abortion, the adjusted relative risk of serious complications associated with the intraamniotic instillation of urea and prostaglandin F2 alpha (the safest abortifacient regimen) was 1.9 times that associated with D&E (95% confidence interval, 1.2-3.1). An analysis of abortion mortality in the United States from 1972 to 1981 revealed a death-to-case rate of 4.9 per 100,000 abortions associated with D&E, 9.6 with instillation methods and over 60 with hysterotomy and hysterectomy. Little information exists concerning potential late sequelae of second-trimester abortion. D&E appears to be the safest method of second-trimester abortion available in the United States.

Abortion, Induced↗