The National Summit on Preconception Care: A Summary of Concepts and Recommendations

The Centers for Disease Control and Prevention (CDC) and 35 partner organizations have engaged in developing an agenda for Preconception Health. A summit was held in June 2005 to discuss the current state of knowledge regarding preconception care and convene a select panel to develop recommendations and action steps for improving the health of women, children, and families through advances in clinical care, public health, and community action. A Select Panel on Preconception Care, convened by CDC, deliberated critical related issues and created refined definition of preconception care. The panel also developed a strategic plan with goals, recommendations, and action steps for improving preconception health. The recommendations and action steps are specific to the implementation of health behavior, access, consumer demand, research, and surveillance activities for monitoring and improving the health of women, children and families. The outcome of the deliberations is the CDC publication of detailed recommendations and action steps in the Morbidity and Mortality Weekly Report series, Recommendations and Reports.

     

Preconception Care for Improving Perinatal Outcomes: The Time to Act

Maternal and Child Health Journal -     

Estimates of the annual number of clinically recognized pregnancies in the United States, 1981-1991.

The authors estimated the number of clinically recognized pregnancies that occurred annually from 1981 to 1991 in the United States by type of outcome and by race. Estimates of the numbers of livebirths, induced abortions, ectopic pregnancies, and fetal deaths were obtained by using data from the Centers for Disease Control and Prevention in Atlanta, Georgia. The number of spontaneous abortions was estimated by using previously published, age-specific rates. More than 67 million pregnancies occurred during the study period. Overall, 62.5% of these pregnancies resulted in livebirths, 21.9% in legal induced abortions, 13.8% in spontaneous abortions, 1.3% in ectopic pregnancies, and 0.5% in fetal deaths. These data can be used to provide denominators for the calculation of a variety of pregnancy outcome-specific rates.     

Low albumin levels are associated with mortality in the critically ill: A retrospective observational study in a multidisciplinary intensive care unit

Background Albumin is a determinant of plasma colloid oncotic pressure and buffering capacity. It is a carrier protein for drugs and is important for normal functioning of the glycocalyx. Hypoalbuminaemia is common in the critically ill and has been associated with adverse outcomes. The association between hypoalbuminaemia and outcome has not been specifically explored in the South African context. Objectives To determine whether albumin levels on admission and changes in albumin levels were associated with intensive care unit (ICU) mortality in a heterogenous critically ill population. Methods This was a retrospective observational study of 247 adult patients who were admitted to a multidisciplinary ICU. Albumin levels were measured on admission and 48 hours later, alongside other biochemical and clinical parameters to determine whether they were predictive of ICU mortality. Results The lowest level of albumin on admission was 8 g/L and the highest was 43 g/L. The incidence of hypoalbuminaemia (using the laboratory reference range) was 93.9% on admission and 99.4% at 48 hours. Receiver operating characteristic curve analysis provided an optimal albumin cut-off of 18.5 g/L. Using this cut-off, hypoalbuminaemia at admission and at 48 hours was associated with increased ICU mortality. Hypoalbuminaemia at admission was an independent predictor of mortality using multivariable analysis (OR 3.74; 95% confidence interval 1.87 - 4.48). Conclusion Hypoalbuminaemia is associated with increased ICU mortality. There is currently no evidence to support the use of albumin replacement therapy. Further research is required to determine its role in critically ill patients. Contributions of the study Hypoalbuminaemia is common in critically ill South African (SA) patients and is associated with increased ICU mortality. This has not been well explored in the SA setting. We found that an optimal albumin cut-off was 18.5 g/L, which was much lower than the limits of the laboratory reference range.     

Ectopic pregnancy concurrent with induced abortion: incidence and mortality

From 1972 through 1985, 24 women who underwent an induced abortion died as a result of a concurrent ectopic pregnancy. We analyzed data from the Joint Program for the Study of Abortion, National Hospital Discharge Survey, and the Centers for Disease Control Ectopic Pregnancy and Abortion Surveillance Systems to determine the incidence and mortality of ectopic pregnancy concurrent with induced abortion. During the period 1971 through 1985, the incidence of ectopic pregnancy concurrent with induced abortions was 1.35/1000 induced abortions, compared with 13.6/1000 pregnancies not terminated by induced or spontaneous abortion. The rate was higher among women who obtained abortions at earlier gestational age and among older women. The death-to-case rate for ectopic pregnancies concurrent with induced abortion was 1.3 times higher than that for women not undergoing abortion. Most of the deaths of women with ectopic pregnancy who underwent induced abortion were attributable to the failure to diagnose the ectopic pregnancy before the woman left the facility where the abortion was performed. Such deaths could be prevented by the provider of the abortion assuring that the tissue is examined for products of conception at the time of the abortion.     

Maternal mortality in the United States: report from the Maternal Mortality Collaborative

To better define the incidence, causes, and risk factors associated with maternal deaths, the Maternal Mortality Collaborative in 1983 initiated national voluntary surveillance of maternal mortality. The Maternal Mortality Collaborative reported 601 maternal deaths from 19 reporting areas for 1980-1985, representing a maternal mortality ratio of 14.1 per 100,000 live births. Overall, 37% more maternal deaths were reported by the Maternal Mortality Collaborative than by the National Center for Health Statistics for these reporting areas. Older women and women of black and other races continued to have higher mortality than younger women and white women. The five most common causes of death for all reported cases were embolism, nonobstetric injuries, hypertensive disease of pregnancy, ectopic pregnancy, and obstetric hemorrhage. Compared with national maternal mortality for 1974-1978, ratios were lower for all causes except for indirect causes, anesthesia, and cerebrovascular accidents. Fatal injuries among pregnant women are not commonly reported to maternal mortality committees. As maternal mortality from direct obstetric causes continues to decline, clinicians will need to emphasize preventing deaths from nonobstetric causes.     

Abortion surveillance, United States, 1984-1985

Since 1983, the number of legal abortions reported to CDC increased by 5% to 1,333,521 in 1984; in 1985, that number decreased by less than 1% to 1,328,570. The national abortion rate was the same for both years-24 per 1,000 females ages 15-44 years. The abortion ratio for 1984 was 364 legally induced abortions per 1,000 live births; the ratio for 1985 was 354 per 1,000. Abortion ratios were higher among women of black and other minority races and among women younger than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. Curettage was the procedure used in 96% of the reported cases. Eleven deaths were associated with legally induced abortions in 1984, and six in 1985. The case-fatality rate in 1985 was 0.5 deaths per 100,000 legally induced abortions, down from the 0.8 per 100,000 reported in 1983 and 1984. Overall, since 1980, the numbers and rates of abortion have had only slight year-to-year fluctuations. The steady increase in the percentage of repeat abortions since 1972 reflects the ongoing availability of legal abortions. Since the beginning of CDC's abortion mortality surveillance, the number of deaths related to legal abortions has decreased 75%, from 24 deaths in 1972 to six deaths in 1985.     

Seroepidemiology of rubella in Bahrain

Although the Ministry of Health of the State of Bahrain has set priorities for vaccination against a number of communicable diseases including the six target diseases of the Expanded Program of Immunization, no such policy for rubella immunization exists. The incidence of rubella in Bahrain is not precisely known nor is the magnitude of the problem of Congenital Rubella Syndrome. A survey of schoolchildren and primigravidae attending antenatal clinics was undertaken in Bahrain to determine the level of natural immunity against rubella in these groups, which we hope would help us in formulating a vaccination policy. We have found that 67.8% of the 6-7 year old children are susceptible to rubella and that by the age of 18 years susceptibility drops to 10.4%. The decrease in susceptibility was significant until the age of 14 years after which the change became minimal. Efforts should ideally be focused on immunizing all susceptible females before they get married. However, at present, it would be more economical to vaccinate all girls premaritally than to screen and vaccinate those susceptible. When a cheaper screening test for assessing immunity against rubella becomes available, a policy of premarital and post-partum screening followed by vaccination of susceptibles should be put into practice.     

Improving women's health for the sake of our children

Improving the health of our children offers the greatest potential for improving the health of our nation. One paradigm for improving the health of children that may offer the greatest rate of return lies in improving the health of women. Throughout the complete life stages of both women and children, overall good health of women positively influences the health and wellness of our children.