Fetal diagnostic indications for second and third trimester outpatient pregnancy termination.

OBJECTIVE: To determine the frequency of diagnostic indications among women seeking to terminate pregnancies for reasons of fetal abnormality, spontaneous fetal demise, or a genetic disorder in a private outpatient clinic specializing in late outpatient abortion procedures. METHOD: A total of 1005 women requested termination of pregnancy for reasons of genetic disorder, fetal anomaly, or fetal demise over 20 years (1992-2012). Gestational ages ranged from 12 to 39 weeks. In all cases, a documented diagnosis of fetal abnormality or fetal demise was made prior to referral. Records were reviewed to verify fetal diagnosis for all patients seeking termination of pregnancy for reasons of fetal disorder. Major complications included major unintended surgery, hemorrhage requiring transfusion, or pelvic infection. RESULTS: Preoperative diagnoses included the following: chromosomal abnormalities (n = 378), genetic syndromes and single gene disorders (n = 30), structural anomalies (n = 494), and other conditions (n = 103). These include 26 cases of spontaneous fetal demise and nine selective terminations of one abnormal twin. The major complication rate was 0.5%. CONCLUSIONS: The majority of diagnoses were in the categories of genetic disorder and neurologic abnormality.

Aligning risk management with patient safety.

There are four key components to the success of HCCI, a captive insurance company formed by five healthcare systems: Common and aligned goals. A commitment to ongoing education. Open and honest dialogue among member-owners. Easy-to-use technology to support information flow and decision making.

Selective termination for fetal anomaly/genetic disorder in twin pregnancy at 32+ menstrual weeks. Report of four cases.

OBJECTIVES: To conduct a pilot study of 4 cases of selective termination of a single abnormal fetus in a dichorionic, diamniotic twin pregnancy advanced to 32 or more menstrual weeks of gestation. STUDY DESIGN: This is a case series of 4 patients in highly unusual circumstances and treatment. Four healthy patients with desired pregnancies complicated by the presence of an abnormal genetic or developmental diagnosis in 1 twin were treated by selective termination of the abnormal twin using intracardiac injection of potassium chloride. RESULTS: In all 4 patients, cardiac arrest in the abnormal twin was effected without disturbance of the healthy twin or the mother. Postoperative maternal serum potassium levels remained at normal levels. Delivery of a healthy surviving twin occurred from 2 days to 4 weeks following the selective termination along with delivery of a stillborn abnormal twin. CONCLUSION: Selective termination of an abnormal twin may be performed on an outpatient basis in the last weeks of pregnancy.

Health and demography of native amazonians: historical perspective and current status

Native Amazonians have been the victims of two massive historical assaults, one at the time of the conquest and the other during the twentieth century. Due to epidemic disease and environmental destruction, many tribes have gone from contact to displacement, decimation, and extinction in a single generation. Deculturation and the construction of large development projects have had catastrophic effects on native populations. In many ways, native Amazonians have experienced a reverse of the "Epidemiologic Transition". Paradoxically, one of the effects of cultural disruption for some native Amazonians has been the loss of cultural controls on fertility with the result that high fertility has become a major health problem. Combined with rapid growth of non-indigenous Amazonian populations, deforestation, and urbanization, native Amazonians face grave obstacles to long-term survival.(AU)

Health and demography of native Amazonians: historical perspective and current status

Os nativos da Amazônia foram vítimas de dois grandes ataques históricos: um na época da Conquista e outro durante o século XX. Devido a doenças epidêmicas e à destruição ambiental, inúmeras tribos passaram a vivenciar problemas de deslocamentos, dizimação e extinção em uma única geração. A acumulação e a construção de grandes projetos desenvolvimentistas tiveram efeitos catastróficos sobre as populaçoes indígenas. Em diversos aspectos, os nativos da Amazônia sofreram uma "Transição Epidemiológica". Paradoxalmente, um dos efeitos da dilaceração cultural para alguns dos nativos da Amazônia foi a perda de controles culturais sobre a fecundidade, fazendo com que a elevada fecundidade se tornasse um importante problema de saúde. Com o rápido crescimento de populaçoes amazônicas não indígenas, o desmatamento e a urbanização, os nativos da Amazônia enfrentam sérios obstáculos para a sua sobrevivência a longo prazo

Alta fecundidad en una comunidad nativa peruana del río Ucayali / High fertility in a Peruvian native community of the Ucayali River

Se trata de un estudio inicial de la fecundidad y los cambios culturales en un pueblo shipibo de la Amazonia peruana. Dicho estudio fue iniciado el año 1964, hasta la actualidad, e incluye los aspectos: social, ambiental, económico, cultural y sanitario. EI crecimiento de la población, en este grupo étnico, alcanza el 5% anual, lo cual es mucho mayor que el hallado por otros investigadores, para otros grupos. Analiza los factores que contribuyen al crecimiento y establece, entre otras cosas, que la reproducción se inicia a una muy temprana edad y se prolonga, hasta alcanzar la etapa final de la edad reproductiva. Observa que el matrimonio es universal y que su alta capacidad reproductiva, se refleja en su corto espaciamiento entre un parte y otro. Concluye que es importante educar a este grupo en la planificación familiar, con el objeto de reducir la mortalidad maternoinfantil, por la alta tasa de nacimientos.

The relation between fertility and cultural change in a peruvian Amazon indian village was studied initially in 1964 and in more detail in 1969. The 1969 study included observations concerning social, economic, environmental, cultural, and health changes. Population growth in the village is nearly 5 %per year, and fertility appears to exceed that previously recorded for other groups. The factors that may be contributing to the high fertility are explored. They are thought to include early and prolonged parity, nearly universal marriage and fertility, high reproductive efficiency, short birth intervals, Western health intervention lowering both infant and maternal mortality rates, and a decline in the prevalence of polygyny.