Luella Klein

Acceptance of amniocentesis by low-income patients in an urban hospital☆☆☆

A study was made of increased accessibility of genetic services to low-income obstetric patients in Atlanta, Georgia. The proportion of black patients averaged 83%. Of 522 patients counseled from August, 1976, through 1978, 157 were offered amniocentesis, and 95 (61%) elected the procedure. For most of the patients (120, or 76%) who were eligible for amniocentesis, age (greater than or equal to 35 years at delivery) was an indication; and of these, only six (5%) had any prior knowledge of genetic risk. During the same time interval, 188 patients over 35 years of age who initiated prenatal care too late for prenatal diagnosis were counseled in the hospital after delivery; 101 (54%) indicated that they would have accepted amniocentesis. The conclusion was that (1) genetic services are acceptable to this socioeconomic group, and (2) accessibility and publicity are needed to promote utilization in this population.

Early teenage pregnancy, contraception, and repeat pregnancy

Abstract A total of 1,824 births to patients aged 16 and under during 1971 and 1972 were examined. Premature birth, and fetal, neonatal, and perinatal death were more common in this young age group. Contraceptive acceptance was high at postpartum visit. Approximately half of the patients registered for continuing interconceptional care. The population is described and contraceptive acceptance, contraceptive continuation, and repeat pregnancy are recorded.

Nonregistered obstetric patients: A report of nine hundred seventy-eight patients

Abstract Sociologic and socioeconomic data from a group of 978 nonregistered patients were compared to data from 1,000 registered patients, and the outcome of pregnancy was recorded for the 978 nonregistered and 5,445 registered patients. Mortality rates of both mothers and infants were higher among patients who failed to register for prenatal care, premature birth was more frequent. Nonregistered patients were more likely to be older and multigravid and have a larger family than registered patients. There was a larger percentage of white patients among the nonregistered patient population. Educational attainment and family income were lower, and household size was larger among patients receiving no antepartum care. Most nonregistered patients had never used any form of contraception, and their postpartum return rate was extremely low.

Human immunodeficiency virus infection among inner-city adolescent parturients undergoing routine voluntary screening July 1987 to March 1991.

Abstract OBJECTIVE : The objective of our study was to describe the human immunodeficiency virus epidemic among pregnant adolescents undergoing follow-up in a large inner-city hospital. STUDY DESIGN : We conducted a case-control study comparing demographic and risk behaviors of seropositive and seronegative adolescents (aged 13 to 20) identified from a population under going routine voluntary antibody screening at Grady Memorial Hospital in Atlanta, Georgia, between July 1987 and March 1991. RESULTS : Of 10,794 pregnant adolescents screened, 51 (4.7/1000) were infected with human immunodeficiency virus. More than one fourth of case patients were ≤17 years old. Significantly more case patients than controls reported a history of crack cocaine use (10 [19.6%] vs 23 [8.2%] p CONCLUSIONS : Pregnant adolescents in our center are at risk for human immunodeficiency virus infection and should be targeted for human immunodeficiency virus education and risk reduction counseling. (Am J Obstet Gynecol 1992;167:1096–9.)

Seroprevalence of human immunodeficiency virus infection in a prenatal population at high risk for HIV infection.

To determine the seroprevalence of human immunodeficiency virus infection in prenatal patients at high risk for HIV infection we tested 513 women from December 1985 through July 1987 at an inner-city hospital in Atlanta, Georgia. Demographic and HIV risk information was collected from all seropositive women. Twenty-nine (6%) of the 513 women tested were positive for HIV on enzyme-linked immunosorbent assay and Western blot analysis. Twenty-six (90%) of seropositive women gave a history of intravenous drug use. Two (7%) had sexual partners known to have AIDS or AIDS-related complex (ARC), and one (3%) was Haitian. Seropositive women were at remarkable risk for other sexually transmitted diseases. The majority of pregnancies ended in term births. This serosurvey defines an obstetric population with a high seroprevalence, and has stimulated us to institute routine voluntary antepartum screening for HIV.