RESUMEN
OBJECTIVE: Our purpose was to update the national estimate of severe pregnancy complications and describe associated maternal characteristics of hospitalizations during pregnancy, applying an expanded definition of maternal morbidity. STUDY DESIGN: From 1991 and 1992 National Hospital Discharge Survey data, we estimated ratios of hospitalizations per 100 deliveries and compared relative ratios by maternal characteristics. We computed standard errors with the SUDAAN program and estimated 95% confidence intervals for relative ratios. RESULTS: The likelihood of hospitalization for pregnancy complications appeared to decline between the period 1986 and 1987 and the period 1991 and 1992, although primarily for pregnancy loss hospitalizations. In 1991 and 1992 there were 18.0 total pregnancy-associated hospitalizations/100 births (17.2 for whites, 28.1 for blacks). Component ratios were 12.3 for obstetric hospitalizations, 4.4 for pregnancy loss hospitalizations, and 1.4 for nonobstetric hospitalizations; all ratios were higher for blacks than for whites. CONCLUSIONS: Maternal hospitalization remains a substantial component of prenatal care. Because of underreporting and changes in medical practice, recent declines in maternal hospitalization may not represent true reductions in maternal morbidity.
Asunto(s)
Hospitalización , Complicaciones del Embarazo/terapia , Aborto Espontáneo , Adolescente , Adulto , Población Negra , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación , Embarazo , Complicaciones del Embarazo/epidemiología , Embarazo en Adolescencia , Factores de Riesgo , Estados Unidos/epidemiología , Población BlancaRESUMEN
Two modified GC-based isotope ratio MS (IRMS) techniques, for measurement of [13C]leucine enrichment in muscle protein, were compared with a conventional dual inlet technique. Of these three, two involved HPLC purification of leucine and liberation of carbon dioxide (CO2) using the ninhydrin reaction. In the conventional technique the CO2 was introduced into the MS by a dual inlet system following cryogenic concentration. In the second method (ninhydrin/GC/IRMS) the CO2 was purified by on-line GC. In the third technique, GC/combustion/IRMS, derivatized amino acids are separated by GC and analyzed after combustion. A primed continuous infusion of L-[1-13C]leucine was given intravenously to human subjects and needle quadriceps muscle biopsies were taken to measure [13C]leucine enrichment in muscle protein. All three methods demonstrated excellent correlation (r > 0. 999). Differences in the measurement of [13C]leucine enrichment in muscle protein were <6%. The ninhydrin techniques require microgram quantities of leucine, with the conventional technique requiring twice the amount as the ninhydrin/GC/IRMS method. The GC/combustion/IRMS technique requires only nanogram quantities of leucine with similar precision enabling measurement of synthesis rates of individual proteins from biopsy samples. We have measured the isotopic enrichment of myosin heavy chain and mixed muscle protein in human subjects using the GC/combustion/IRMS technique.