Obstetrics and gynecology
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The maternal mortality ratio in New York City during the 3-year period of 1981-1983 was 36.1 deaths per 100,000 live births. Eight (7%) of 120 deaths occurred more than 42 days after termination of the pregnancy. Eighteen (15%) of the cases involved white, non-Hispanic women, 66 (55%) were black, and 32 (27%) were Hispanic. ⋯ Increasing age and parity were associated with greater maternal mortality ratios. The leading causes of pregnancy-associated mortality were found to be ectopic pregnancy, pulmonary embolism, anesthetic complications, amniotic fluid embolism, intracranial hemorrhage, hypertensive diseases of pregnancy, infection, and cardiac disease. Abortion-related mortality was about nine times less than the maternal mortality ratio, and the cesarean death-to-case rates could be considered roughly comparable to overall maternal mortality.
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Obstetrics and gynecology · Sep 1990
Case ReportsSevere congestive heart failure and cardiomyopathy as a complication of myotonic dystrophy in pregnancy.
The pregnancy of a patient with myotonic dystrophy and heart failure due to cardiac involvement is described. Endomyocardial biopsy was performed at 32 weeks' gestation with echocardiographic guidance to establish the diagnosis. Severe congestive heart failure, refractory to conventional therapy, was encountered. Continuous arteriovenous hemofiltration was used to relieve pulmonary edema before cesarean delivery.
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Obstetrics and gynecology · Aug 1990
Why do physicians stop practicing obstetrics? The impact of malpractice claims.
We studied all physicians who purchased obstetric malpractice insurance from the Washington State Physicians Insurance Exchange and Association between January 1, 1982 and July 1, 1988. Of the 690 physicians studied, 171 (32% of the family physicians and 10% of the obstetricians) discontinued obstetrics but remained in practice. Physicians who discontinued obstetric practice were older, more likely to practice in an urban area, and more likely to be in solo practice than those who did not. ⋯ By contrast, those family physicians leaving obstetrics had a lower rate of new claims than their peers who did not quit. We conclude that older physicians--particularly those in urban and solo practice--are most likely to stop practicing obstetrics, regardless of specialty. In addition, being named as the target of an obstetric malpractice claim plays a significant role in the decision of some obstetricians to discontinue obstetric practice.
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Obstetrics and gynecology · Jul 1990
The quality of dying: financial, psychological, and ethical dilemmas.
The quality of life of terminally ill patients depends on the information base and psychosocial skills of their health care team. Patients have the right to choose to forego medical care, and it is important to learn the who, what, when, and where of informing a patient and supporting their decisions. ⋯ The impoverishment of the family, monetarily and physically; the denial of alternatives, even though potentially more cost-effective; and lack of coverage for a significant portion of the patient population can make humane care at the end of life impossible. Physicians have an ethical responsibility to inform themselves about terminal care and to advocate improved coverage at the end of life.