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Biomedical subjects

K F Schulz

Publications and source records attributed to K F Schulz.

At least 91 records · Page 5Linked to original sources
PubMed1985

Hysterectomy performed within 1 year after tubal sterilization.

In the United States, approximately 650,000 women of reproductive age undergo tubal sterilization each year and some of these women later have hysterectomies. Little is known about risk factors for having hysterectomy after tubal sterilization. For examination of this issue, we analyzed data from the Collaborative Review of Sterilization, an ongoing multicenter prospective study designed to assess the safety and efficacy of female sterilization operations. In 1979 and 1980, 4002 women 15 to 44 years of age had interval tubal sterilization; of these women, 64 had hysterectomies within 15 months, which yielded a cumulative incidence of 1.6%. Women with a history of menstrual complaints, leiomyomata, ovarian cysts, or endometriosis before their tubal sterilization had an increased risk of hysterectomy, compared with women without such a history. However, 98% of women with a history of these conditions did not have a hysterectomy within 15 months after tubal sterilization. Further follow-up of these women should help to better delineate their long-term risks.

Adolescent↗
PubMed1985

The comparative safety of second-trimester abortion methods.

The comparative safety of methods used to perform second-trimester abortion is an important public health concern. Morbidity and mortality studies indicate that dilatation and evacuation (D & E) is safer than instillation abortion, which is safer than hysterotomy or hysterectomy. In the third phase of the Joint Program for the Study of Abortion, the adjusted relative risk of serious complications associated with intra-amniotic 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). Surveillance 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 or hysterectomy. Little information exists on 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↗
PubMed1985

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↗
PubMed1985

Abortions that fail.

In this study of 33,090 suction curettage abortions performed at less than or equal to 12 weeks' gestation, the rate of unrecognized failed abortions was 2.3 per 1000 abortions. Women with one or more prior pregnancies and those having an abortion at less than or equal to six weeks' gestation, particularly when small suction cannulae were used, were at higher risk for this complication (relative risks of 2.2, 2.9, and 11.1, respectively). Failures were also more likely when abortions were performed by resident physicians (relative risk of 2.2) and when they were performed on women with uterine anomalies (relative risk of 90.6). Physicians can minimize the risk of failed abortion by selecting an appropriate suction cannula size and by planning the optimal time to perform the abortion. Likewise, abortions performed either by residents or on women with uterine anomalies merit extra care.

Abortion, Legal↗
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↗
PubMed1984

Prophylactic antibiotics for curettage abortion.

Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion. Six studies, including three randomized clinical trials, suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half. Three other studies, two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion, support the hypothesis that antimicrobial prophylaxis reduces morbidity. Tetracyclines are commonly used for this purpose. The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both short-term morbidity and potential late sequelae, such as ectopic pregnancy and infertility.

Abortion, Induced↗
PubMed1984

Prevention of uterine perforation during curettage abortion.

Although uterine perforation is a potentially life-threatening complication of curettage abortion, little is known about the risk factors associated with uterine perforation or how to prevent it. Using linear logistic regression, we analyzed 67,175 curettage abortions performed at 13 institutions in the United States from 1975 through 1978. The overall incidence of confirmed perforation was 0.9 per 1,000 abortions. Performance of the abortion by a resident rather than by an attending physician was a powerful risk factor for perforation (relative risk, 5.5; 95% confidence interval, 3.3 to 9.2). Use of Laminaria for dilation had a protective effect, although this effect was not statistically significant (relative risk, 0.17; 95% confidence interval, 0.02 to 1.2). Among factors beyond the control of the physician, advancement of gestational age and previous delivery were significant risk factors. Use of Laminaria and performance of the abortion by an attending physician considerably lowered the risk of uterine perforation.

Abortion, Induced↗
PubMed1984

Midtrimester abortion. Intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha v dilatation and evacuation.

Although dilatation and evacuation (D&E) is currently the most common method of midtrimester abortion in the United States, the intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P) has been proposed as a safer technique. To evaluate the comparative safety of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13 to 24 menstrual weeks' gestation. The U-P procedure resulted in significantly more serious complications than D&E (1.03 v 0.49 per 100 abortions). After adjusting for patient age, race, parity, follow-up information, and preexisting conditions, the relative risk of serious complications associated with U-P was 1.9 (95% confidence interval, 1.2 to 3.1). This advantage for D&E stems from its applicability to the 13- to 16-week interval. Although D&E appears to be safer overall in the midtrimester, for women obtaining abortion after 16 weeks, the rates of serious complications were comparable, with a relative risk of 1.0 (95% confidence interval, 0.4 to 2.5).

Abortion, Induced↗
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

Estimators of relative risk for case-control studies.

The odds ratio from a case-control study of the "cumulative-incidence" type can be used as an estimate of the relative risk of a disease attributable to exposure to an agent only when the incidence of the disease is low. The odds ratio can be modified to obtain an accurate estimate of the relative risk, regardless of the incidence of the disease. This modification of the odds ratio can be performed with any one of four types of auxiliary information: overall probability of disease, probability of disease in the unexposed population, probability of disease in the exposed population, or overall probability of exposure. For "incidence density" case-control studies, the odds ratio equals the relative risk when the estimate of exposure in the comparison group can be considered to be an estimate of the overall probability of exposure in the population at risk. Under certain conditions, such "case-exposure" studies may be preferable to cohort studies and to cumulative-incidence case-control studies. The authors present an approach to hypothesis testing for crude and stratified data from a case-exposure study.

Abortion, Spontaneous↗
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

Identifying neonatal risk factors and predicting neonatal deaths in Georgia.

A predictive model which identifies 38% of the neonatal deaths by isolating only 11% of the births was formulated. It utilized existing vital records data for 230,585 single live births which occurred in Georgia for the period 1974-1976, to describe factors recorded on the birth certificate which are determinants of neonatal mortality on a statewide basis. Maternal age, race, premature birth, spontaneous abortion or stillbirth, complications related to pregnancy, complications not related to pregnancy, and type of birth (multiple gestation) were found to be statistically significant. It is proposed that private physicians evaluate patients on the basis of this model to facilitate estimates of risk of a neonatal death. In addition, public health physicians could utilize this model to make informed decisions in regard to the management of public health programs directed at the care of pregnant women.

Female↗
PubMed1982

Family planning and abortion: have they affected fertility in Tennessee?

In Tennessee between 1975 and 1978, birth rates among teenagers decreased while they increased among older age groups. This trend was unlike previous years and coincided temporally with the increased availability of legal abortion services in Tennessee and the special efforts to prevent unwanted pregnancies among teenagers. Increased use of family planning services was significantly associated with the drop in the fertility rate for Black teenagers; legal abortion use was significantly associated with the change in the fertility rate for Black females aged 20 years or older.

Abortion, Legal↗