Roundtable: historians and the Webster case.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to W Chavkin.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
From 1981 to 1988, eighty percent of all women with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control were of reproductive age. Six pregnancy-associated deaths due to AIDS in this country have been reported in the medical literature. We identified 20 unpublished cases of women who died of AIDS during or within one year after termination of pregnancy. Analysis showed that these women were mostly black or Hispanic, half were intravenous drug abusers, and most died of Pneumocystis carinii pneumonia. Each pregnancy had an obstetric complication, primarily preterm delivery. The interval between diagnosis of AIDS and the death of these women ranged from one day to 15 months, with a mean interval of 113 days. Multiple reporting sources increased case detection and should be used for future investigations. Prospective case-control studies are needed to determine any further relationship between pregnancy complications and AIDS.
Explore the source record for details and available documents.
"People from the Caribbean represent one of the largest immigrant groups in New York City. This study focuses on the reproductive health of first generation Caribbean immigrants. Birth and death certificate data were used to generate descriptive profiles of risk-factor prevalence and reproductive outcomes to Caribbean and comparison populations." Data on single live births for 1980-1984 take into consideration ethnic differences, age, place of birth, parity, mother's education, method of payment for health care, prenatal care, and birth weight.
Explore the source record for details and available documents.
An increasing proportion of obstetric patients are working women. This widens the world of concern for the obstetrician, who must now become familiar with the consequences of workplace exposures and conditions for both maternal and fetal health. This review briefly explores interactions between chemical and physical hazards on the job and the physiologic changes of pregnancy in order to propose ways in which the obstetrician can intervene on behalf of the individual patient, as well as on the public level. Through discussion of the Pregnancy Discrimination Act, job transfer and modification, disability, breastfeeding, etc., emphasis is placed on the social and policy factors that affect reproductive outcome for the working pregnant woman.
The rate of ectopic pregnancies has been rising in the past decade and it is responsible for an increasing proportion of maternal deaths. A history of pelvic inflammatory disease is strongly associated with ectopic pregnancy. There is a higher rate of ectopic pregnancy among intrauterine device users than non-users. A history of abdominal surgery has been associated with ectopic pregnancy and there is some evidence that women taking certain hormonal preparations experience excess ectopic pregnancies. Through a critical review of the literature, the author explores the evidence for these associations. The paper closes with recommendations for future research.
Explore the source record for details and available documents.
One hundred forty six crack/cocaine using mothers in New York City were interviewed in a cross sectional study about life histories and drug related behaviors. Forty one (28%) reported histories of previous psychiatric medication or hospitalization. These women were significantly more likely than the rest of the sample to currently be in drug treatment; to have sexual abuse histories; and to be currently involved with men who urged them to use crack during pregnancy. Within this group, two subgroups were distinguishable: one, who had been sexually abused and initiated drug use early, and the other whose psychiatric and drug use histories were not associated with sexual abuse. The implications of these findings for screening, treatment planning, and future research are discussed.
We recognize that many of the issues raised are not simple. Our proposal calls for the same thoughtful deliberation applied in other settings to be brought to bear on reproductive health care. Some have already tried alternative approaches. In Albuquerque, New Mexico, a university hospital neonatologist and the district attorney have collaborated to create an alternative to sentencing program for women who are arrested for drug-related crimes and found to be both pregnant and drug addicted. Rather than proceed with criminal sanctions, these women are offered entry into a drug treatment program that is geared to families with young children and run by the pediatrics department. Here, the physician and the district attorney collaboratively responded in ways congruent with the professional integrity of each. In another example in Portland, Oregon, physicians, drug treatment providers, and child protective social service representatives cooperatively defeated a legislative proposal to mandatorily test and report pregnant women for illicit drug use and, instead, formed a task force to jointly develop state policy regarding the issue. Drug use, HIV infection, child abuse, and poverty are all cause for alarm. Yet it is critical that our frustration about these difficult problems not be translated into blaming individuals for "deviance," or into short-term inadequate responses. In developing policy we should consider the impact on the legal and ethical rights and obligations of both patient and physician. For every course, we should evaluate both immediate and long-term efficacy, the consequences for the doctor-patient relationship, and the consequences for medical integrity. In the midst of the present regulatory and fiscal turmoil affecting health care, we urge physicians to be careful and deliberate in the policies they embrace and the actions they take.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The United States has lagged behind other developed nations with respect to infant and maternal mortality. In the past decade, the disparities between races and socioeconomic groups has actually widened. In response, local initiatives have sought to decrease infant mortality by enrolling women into prenatal care programs. These programs have focused solely on pregnancy, despite evidence that access to family planning, abortion, and gynecologic care is necessary to reduce both infant and maternal mortality. These prenatal care initiatives thus miss the opportunity to have an impact on some of the major public health issues facing women.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.