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58% of currently married women in Japan were current users of contraception in 1990. The condom was the most popular method, with a use rate of 43%, followed by natural family planning methods (9%). The unusual popularity of the condom is, in part, explained by the nonavailability of oral contraceptives (OCs); the pill is illegal in Japan because of government concerns about its side effects. However, the Ministry of Health has given Japanese pharmaceutical companies permission to develop a low-dose OC assumed to lower the risks of hypertension, stroke, and heart disease that should become available soon. In anticipation of this move, the 1986 and 1990 National Surveys on Family Planning asked respondents their views on OC legalization and whether they would become acceptors. 10% of women in both surveys indicated they intended to use the pill and another third were uncertain. Intention to use the pill was related to recognition of its high effectiveness and a desire to reduce the need for abortion. 29% of respondents in the 1990 survey reported a least 1 abortion, and 25% had been using contraception at the time their last pregnancy occurred. Logit regression revealed that intent to seek abortion in the event of another pregnancy and joint family type were the only factors, after adjustment, significantly associated with planned OC use; age, educational level, and employment status were not significant. The surveys further revealed a need to reassure Japanese women about the pill's safety if acceptance rated exceeding 10% are to be achieved. 13% of 1986 respondents and 21% of those interviewed in 1990 stated opposition to legalization of the pill and 48% in both surveys were uncertain. 77% of women in the 1986 survey and 70% of those in 1990 cited concerns about pill safety as a reason for their opposition.
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PMID:Prospects for increased contraceptive pill use in Japan. 179 77

Uterine velocimetry was performed in 13 pregnant women with pregnancy induced hypertension (PIH) and in 15 pregnant women with recurrent spontaneous abortion syndrome (RSA-S). Measurement were performed on both uterine arteries and averaged. 75% of PIH group had RI 95th percentile from the first measurement (20 weeks gestation). In the RSA-S group, RI was between 75th and 95th percentile, suggesting an almost pathological vascularization.
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PMID:Uteroplacental blood flow in pregnant women with hypertension and recurrent spontaneous abortion. 180 25

An analysis of trends in numbers, rates, and outcomes of pregnancies in women of 19 years and less was performed using population-based data from the Registrar General of Scotland, of all deliveries in Scottish hospitals from 1975 to 1988. The data were taken from the standard maternity discharge document including live and stillbirths, and from the 1975-87 Notifications of Abortion records. Pregnancies/1000 women ranged from 40 in 1983 to 50 in 1975. Proportionally more pregnancies were terminated in 1987. The number of live births to single women rose from 11.4 to 22.2/1000 over the period. In 1987 there were fewer marriages during pregnancy, and a lower proportion of pregnancies in married women. The total number of live births to women 20 decreased from 8267 in 1975 to 6158 in 1988, while those in single women rose from 2297 to 4558, from 28% to 74%. There were no evident trends in teen pregnancies, but an increase in the termination rate in teens was apparent. Most teen births occurred in mature out-of-school women. While 32% of primiparous women aged 18 booked for prenatal care at 21 weeks or more, there was no increase in anencephaly or spina bifida, which would have been detected by prenatal screening. Hypertension occurred in 14% of women 20 and in 21% of those 20. Operative deliveries were more common in women aged 20-24, and more often resulted in low birth weight. Low birth weight occurred in 8% of women, compared with 7% in those 20 (p0.01). When social factors were controlled, there were no differences in birth weight and gestation length. Indicators of social deprivation are discussed. The longterm implications of loss of education, training, employment, and stable marriages were considered more detrimental to the young mothers than the adverse health effects of early pregnancy.
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PMID:Teenage pregnancy in Scotland: trends and risks. 180 77

Physicians analyzed 1983-88 data on 99 maternal deaths in the netherlands to examine causes of death and to what degree substandard care contributed to the deaths. 65 cases were classified as direct maternal deaths, 14 ad indirect maternal deaths, and 20 as fortuitous maternal deaths. They did not include the 20 fortuitous deaths in the maternal mortality rate which stood at 8.8/100,000 live births. The physicians knew all the details in 66 maternal deaths. They identified substandard factors in 57% of these cases. Most of the cases associated with substandard care were women with pregnancy induced hypertension (eclampsia). The substandard care factors included patient or physician's delay, wrong diagnosis, insufficient knowledge of proper treatment, operating without knowledge of clotting disorders, interventions on patients in an unstable condition, inadequate postpartum and postoperative surveillance, and lack of organization. The leading direct cause of maternal death was eclampsia (34%) then thromboembolism (21%), and obstetric hemorrhage (19%). 41% of the women who died from eclampsia also suffered from cerebrovascular hemorrhage. Only 2 women died from septic abortion. The major indirect cause of maternal death was cerebrovascular hemorrhage (57%). Among the direct maternal deaths, 52% had disseminated intravascular coagulation and 25% had a cesarean section. As recently as 1935 in developed countries, puerperal sepsis was the leading cause of maternal deaths (50%) then obstetrical hemorrhage and eclampsia (25%). Mortality rates began to fall with the introduction of sulphonamides and later penicillin. In developing countries, however, maternal mortality remains very high. High rates are due to high fertility and a high risk of death each time a woman is pregnant. Availability of safe contraception and elimination of illegal abortions would reduce maternal mortality considerably.
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PMID:Maternal mortality and its prevention. 180 6

The objectives was to assess the determinants of and rates of abortion, stillbirth, and infant mortality for a cohort of pregnant women from slums in New Delhi, Calcutta, and Madras, India and rural slums in Hyderabad, Varanasi, and Chandigarh, India in 1981. The relationship of low birthweight (LBW) and high risk pregnancies to social, environmental, nutritional, cultural, and biological factors was of interest. The results showed variation both between and within urban and rural areas. Rural pregnancy outcome showed fewer LBWs and perinatal and neonatal mortality. Perinatal, neonatal, and infant mortality rates were consistent with prior findings. There was a demonstrated need for prenatal care and referral due to the 10-12% with a poor obstetric history and the significant number with anemia, bleeding, hypertension, toxemia, and urinary tract infections during this pregnancy. Many women were malnourished (body weight 40 kg, height 145 cm, and midarm circumference of 22.5 cm. These women can be identified as high risk. Other risk factors identified were women with disadvantageous personal habits: smoking, alcohol use, tobacco chewing, and working. 10-25% of pregnancies were not registered even though the prenatal clinic was accessible and outreach was provided. 20% completed the recommended number of prenatal visits. 75-85% visited at least once and sometimes more often. Screening for high risk must be done at the 1st visit. Women had strong feelings about the preference for a Dai during delivery and for place of delivery. Poor training of health workers was reflected in the lack of adequate sanitation during the birthing process. Neonatal units were lacking and primary care absent. 10-14% of births were preterm of which 50% occurred at 36 weeks. Multiple regression identified risk factors for fetal and neonatal mortality and LBW as maternal age, preterm birth, maternal anemia, previous preterm or LBW, birth interval, and previous fetal and neonatal mortality. Recommendations are for improving sanitation, hygiene, and water supplies, promoting community awareness of the adverse effects of early marriage and close birth spacing, improving the delivery of health care, allocating health resources based on morality rates, using an intersectoral approach for dealing with the complex social and personal habits adversely affecting childbearing and 7 other suggestions. Existing services and their use are inadequate.
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PMID:ICMR Task Force National Collaborative Study on Identification of High Risk Families, Mothers and Outcome of their Off-springs with particular reference to the problem of maternal nutrition, low birth weight, perinatal and infant morbidity and mortality in rural and urban slum communities. Summary, conclusions and recommendations. 181 69

Between 1975 and 1988 authors encountered 44 pregnancies in 26 women who had had chronic renal disease and unimpaired renal function before the conception. Complications during pregnancy and the outcome of pregnancy were studied. There were 5 spontaneous abortions between the 11th and 20th weeks of gestation, 1 therapeutic abortion, 3 still births at weeks 28, 32 and 33, 6 neonatal deaths at age of 26 to 35 weeks, 11 preterm newborns, 35 live births, 9 infants with intrauterine growth retardation including 4 preterm newborns and 1 fetal malformation and 2 cases with premature rupture of the fetal membranes. The pregnancies were complicated with anaemia in 23 cases, with urinary tract infection in 19, with hypertension in 16, with proteinuria in 12 and with edema in 11 cases. Increase in the serum creatinine value during pregnancy was found in 6 cases. These data indicate that the pregnancy in patients with chronic renal disease who had normal renal function before the planned conception, is accompanied with increased risk for both the mother and child.
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PMID:Pregnancy in women with chronic renal disease: a 14-year study. 181 86

We analysed the outcome of pregnancy in patients with pre-existing lupus nephritis, seen in a tertiary referral centre for nephrology. Fifty-three pregnancies in 25 patients who already had clinical and histological evidence of lupus nephritis were recorded between January 1970 and June 1989, and data were analysed retrospectively. All 53 pregnancies occurred in patients with more or less stable disease, while three pregnancies during which lupus first presented were excluded. Six pregnancies were ended by therapeutic abortions (four for social reasons), and in eight spontaneous abortion occurred. Thus, 39 deliveries occurred, 28 at 36 weeks or more, while 11 were delivered prematurely, of which one was a stillbirth. After allowance was made for therapeutic abortions, the fetal loss rate (9/47) was 19%. Seventeen Caesarian sections were performed in the 39 completed pregnancies (44%), 11 as emergencies. Although the overall fetal loss, incidence of premature births and Caesarian section rate were all higher than expected for a population of normal women, neither initial histology, treated hypertension, the presence of proteinuria or a nephrotic syndrome showed statistically significant relationships with the outcome of completed pregnancies. In no case was maternal renal function affected irreversibly, although proteinuria increased substantially during pregnancy in six patients, and creatinine clearance fell during pregnancy, also in six patients. No 'flares' in systemic disease were seen, but all patients save five were treated with a brief period of high-dose oral corticosteroids or intravenous methylprednisolone in the postpartum period. No case of neonatal lupus or congenital heart block was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The outcome of pregnancy in women with lupus nephritis. 184 58

Much of the morbidity and mortality in sickle cell disease (SCD) is caused by tissue ischemia and infarction resulting from vascular occlusion. Research in this area has been dominated by the hypothesis that vascular occlusion in SCD is due primarily to microvascular obstruction by sickle erythrocytes (SS RBC), yet there is no direct evidence that microvascular occlusion is responsible for any of the vasocclusive complications of SCD. In this paper an alternate hypothesis is proposed: that thrombotic occlusion of larger arteries and veins is an important factor in many of the vasocclusive complications of SCD. Large-vessel cerebral arterial disease (intimal hyperplasia with superimposed thrombosis) has clearly been established as the most important cause of stroke in SCD, and considerable evidence suggests that pulmonary arterial thrombosis/embolism is a major cause of pulmonary infarction and hypertension. The involvement of large-vessel thrombosis in painful crisis, aseptic necrosis of bone, priapism, leg ulcers, retinopathy, and miscarriage has not been adequately investigated. Large-vessel occlusion in SCD is probably a consequence of the abnormal adhesive and procoagulant properties of SS RBC, which produce endothelial damage, secondary intimal proliferation, and thrombosis. Techniques currently used to treat large-vessel occlusion in other disorders (antiplatelet and anticoagulant agents, thrombolytic therapy, angioplasty, endarterectomy, and vascular bypass surgery) should be considered in sickle cell subjects with large-vessel occlusion, especially in the cerebral vasculature.
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PMID:Large-vessel occlusion in sickle cell disease: pathogenesis, clinical consequences, and therapeutic implications. 189 Sep 82

A tree of impact diagram is a method of predicting the possible outcomes of proposed changes or innovations on current practices. Teenage pregnancy is an issue that has a great deal of personal, social and financial consequences for the teenagers, their families, and society. The consequences of repealing the laws that currently allow abortion can be discovered through a tree of impact model. Teenage pregnancy rose sharply after WWII. In 1945 the rate was 5.15/1000 women, and its peak was 1957 with 96.3/1000. During this period there were no contraceptives and abortion was illegal. By 1970 half the teenagers surveyed had engaged in sexual activity by age 17. In 1990 there were 831,000 teenage pregnancies with 382,000 ending in abortion. The WHO determined that 20-25% of maternal mortality was the result of illegal abortion. Medical abortion has a maternal death rate of .6/100,000. Teenage pregnancy cost the federal government $16.65 billion in 1985 and it is estimated that each of these families will cost an additional $13,902/year for the next 20 years. Risk of perinatal morbidity and mortality is highest among the youngest mothers, age 15 and younger. Hypertension caused by pregnancies occurs in 7-17% of the population compared to 34% when the youngest mothers are included. Adoption while an option is one that few teenagers choose. In 1971 18% of white teenage mothers and 2% of black teenage mothers chose adoption. In 1982 these figures dropped to 7.4% and 1%. Both sides of the abortion debate agree that teenage pregnancy is a problem. Both sides agree that something should be done to reduce the number of teenage pregnancies. There have be pilot projects and studies that have shown several successful methods of reducing teenage pregnancies. Some include self esteem/social skill building and others encourage educational attainment.
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PMID:A tree of impact model. Evaluation of consequences of repeal of the abortion law on teenage pregnancy. 193 Dec 64

The morphology of the human placental bed is reviewed. The pathological features seen in spontaneous abortion, pregnancy-induced hypertension, intrauterine growth retardation, placenta accreta and postpartum haemorrhage suggest that abnormal placentation may be a common feature. A defect in the normal materno-trophoblastic interaction is implicated in the pathogenesis of abnormal placentation.
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PMID:The human placental bed in health and disease. 195 24


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