Biomedical subjects

Jeffrey Ecker

Publications and source records attributed to Jeffrey Ecker.

6 recordsLinked to original sources

PubMed2004

Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation.

OBJECTIVE: To examine maternal and neonatal outcomes in expectant management of spontaneous preterm premature rupture of membranes (PPROM) before 24 weeks. STUDY DESIGN: Patients presenting with spontaneous PPROM from 14 to 23 completed weeks' gestation between January 1, 1995 and December 31, 1999 were reviewed. A total of 108 pregnancies were evaluated; 57 patients elected expectant management. RESULTS: Median latency from rupture of membranes (ROM) to delivery was 6 days; the overall survival rate was 26.3%. In ROM <20 weeks, a twin and a triplet pregnancy with loss of the presenting fetuses yielded the only survivors. In patients with ROM from 20 to 21 and 22 to 23 weeks, survival rates were 2/16 (12.5%) and 11/20 (55.0%), respectively. In all, 18/57 (31.6%) of patients developed chorioamnionitis. There was no maternal sepsis or death. There were three cases of pulmonary hypoplasia, all in patients with ROM <20 weeks. CONCLUSIONS: Neonatal survival in spontaneous PPROM before 20 weeks is rare, irrespective of latency from ROM to delivery. When PPROM occurs from 20 to 24 weeks, survival improves with increasing gestational age at ROM and at delivery.

Adolescent↗

PubMed2004

First trimester placental growth factor and soluble fms-like tyrosine kinase 1 and risk for preeclampsia.

An imbalance of pro- and antiangiogenic factors may lead to preeclampsia (PE). In this prospective nested case-control study, we investigated whether first trimester serum levels of placental growth factor (PlGF), a potent angiogenic factor, and its soluble inhibitor, soluble fms-like tyrosine kinase 1 (sFlt1), distinguished women who developed PE (n = 40) from those who developed gestational hypertension (n = 40), delivered a small for gestational age (SGA) newborn (n = 40), or completed a full term normal pregnancy (n = 80). Compared with controls, serum PlGF levels were lower among women who developed PE (23 +/- 24 pg/ml vs. 63 +/- 145 pg/ml; P < 0.01) or gestational hypertension (27 +/- 19 pg/ml; P = 0.03), or who delivered a SGA newborn (21 +/- 16 pg/ml; P < 0.01). In contrast, serum sFlt1 levels did not markedly differ between the groups: PE, 1048 +/- 657 pg/ml; gestational hypertension, 942 +/- 437 pg/ml; SGA newborns, 1011 +/- 479 pg/ml; and normal controls, 973 +/- 490 pg/ml. Multivariable analysis adjusting for potential confounders and serum sFlt1 levels demonstrated a 3.7-fold (95% confidence interval, 1.2-12.5) increase in risk for PE for every log unit decrease in serum levels of PlGF compared with controls. Analyses for gestational hypertension and SGA were not significant. Examined in tertiles, the risk for PE was increased 28.7-fold (95% confidence interval, 2.3-351.0) in the third (<12 pg/ml) compared with the first (>39 pg/ml) PlGF tertile. First trimester serum levels of PlGF and sFlt1 may identify women at high risk for PE.

Adult↗

PubMed2003

"Real World" compliance with strategies to prevent early-onset group B streptococcal disease.

OBJECTIVE: To assess the "real-world" compliance with risk- and culture-based strategies to prevent early-onset group B streptococcal disease. STUDY DESIGN: We retrospectively reviewed the medical records of consecutive term pregnancies delivered at three institutions (a subset of practices at an academic hospital using the culture-based strategy, an academic hospital using the risk-based strategy, and a community hospital using both) between January and March 1998. We abstracted demographic data and risk factors for group B streptococcus, group B streptococcal culture information, documentation of intrapartum antibiotic prophylaxis, and adverse drug reactions. We compared intrapartum compliance with the intended strategy. RESULTS: There were a total of 505 women managed with the risk-based strategy. Of those, 79 had a risk factor for group B streptococcal disease and 72/79 (91.1%) received intrapartum antibiotic prophylaxis. There were a total of 428 women managed with the culture-based strategy. Of those, 70 had positive cultures and 67 (95.7%) received intrapartum antibiotic prophylaxis. An additional 39 women in the culture-based group had no documentation that cultures had been done. Of those, eight (20.5%) had risk factors and all eight received intrapartum antibiotic prophylaxis. Compliance with the risk-based strategy was 91.1 versus 96.2% with the culture-based strategy (p=0.3). Among women managed using the risk-based strategy, 5/426 (1.2%) received intrapartum antibiotic prophylaxis without an identifiable risk factor. Among women in the culture-based strategy, 5/359 (1.4%) received intrapartum antibiotic prophylaxis with documented negative group B streptococcal cultures (p=0.5). When examined by site, compliance with the intended strategy was 91.2% at the academic hospital using the risk-based strategy, 100% at the academic hospital using the culture-based strategy, 90.9% at the community practices using the risk-based strategy, and 82.4% at the community practices using the culture-based strategy. CONCLUSION: Overall, intrapartum compliance with the risk-based approach was similar to the culture-based approach. However, there were more cultures not done and cultures done at inappropriate gestations at the community hospital practice.

Antibiotic Prophylaxis↗

PubMed2003

Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care.

OBJECTIVE: We compared outcomes, safety, and resource utilization in a collaborative management birth center model of perinatal care versus traditional physician-based care. METHODS: We studied 2957 low-risk, low-income women: 1808 receiving collaborative care and 1149 receiving traditional care. RESULTS: Major antepartum (adjusted risk difference [RD] = -0.5%; 95% confidence interval [CI] = -2.5, 1.5), intrapartum (adjusted RD = 0.8%; 95% CI = -2.4, 4.0), and neonatal (adjusted RD = -1.8%; 95% CI = -3.8, 0.1) complications were similar, as were neonatal intensive care unit admissions (adjusted RD = -1.3%; 95% CI = -3.8, 1.1). Collaborative care had a greater number of normal spontaneous vaginal deliveries (adjusted RD = 14.9%; 95% CI = 11.5, 18.3) and less use of epidural anesthesia (adjusted RD = -35.7%; 95% CI = -39.5, -31.8). CONCLUSIONS: For low-risk women, both scenarios result in safe outcomes for mothers and babies. However, fewer operative deliveries and medical resources were used in collaborative care.

Adult↗

PubMed2002

Mood disturbance in pregnancy and the mode of delivery.

OBJECTIVE: In prior studies, mood disturbance has been associated with poor obstetric outcomes. The purpose of this study was to determine whether depression during pregnancy is associated with a higher frequency of cesarean or assisted vaginal delivery. STUDY DESIGN: A mood disorders questionnaire, which included the standardized Center for Epidemiologic Studies Depression Scale (CES-D), was offered to all antenatal patients in their early third trimester from January 1996 to December 1999 at the Massachusetts General Hospital. Maternal demographics and pregnancy outcome data were collected from a computerized database on 1697 patients who completed the surveys. A CES-D score of 16 or higher was considered to indicate significant depressive symptoms. Rates of cesarean section and assisted vaginal delivery in women with and without scores of 16 or higher were compared by using the chi(2) test. RESULTS: Of the study population, 264 women (15.6%) had CES-D scores of 16 or higher. Among all subjects, the cesarean section rate was 24.0%, and the assisted vaginal delivery rate was 10.0%. There was no statistically significant difference between the rate of cesarean section (26.5% vs 23.6%) or assisted vaginal delivery (8.0% vs 10.4%) in women with and without elevated CES-D scores (P =.34). These findings did not change when nulliparous and multiparous patients were analyzed separately, when the definition of patients at risk for depression was expanded to include women who indicated current or past use of antidepressants or when the cutoff CES-D score criteria was increased to 19 or 25. With our sample size, an alpha =.05 and a beta =.2, we had the power to detect a 7.5% difference between our two groups. CONCLUSION: Data from this study did not support a relationship between depressive symptoms during pregnancy and mode of delivery.

Adult↗

PubMedDate not supplied

Impact of collaborative management and early admission in labor on method of delivery.

OBJECTIVE: This study compared the effects of early admission in labor and perinatal care provider on delivery method. Higher spontaneous vaginal delivery rates for certified nurse midwives as compared with physicians have been reported in observational studies and randomized clinical trials. Certified nurse midwives, with their more expectant approach to labor management, would be expected to admit women later in labor than obstetricians. METHODS: Prospective cohort study of 2,196 low-risk pregnancies, with singleton, vertex infants admitted in spontaneous labor. Independent and joint effects of perinatal care provider and cervical dilation at admission on delivery method were evaluated. Confounding was addressed using restriction and multiple regression. RESULTS: Fewer (23.4%) women in collaborative care were admitted in early labor (< 4 cm cervical dilation) than women managed by obstetricians (95% CI = -27.6 to -19.2). Obstetrician care had 9% to 30% fewer spontaneous vaginal deliveries. Women admitted early in labor also had 6% to 34% fewer spontaneous vaginal deliveries. Evaluation of joint effects suggested that interaction between obstetrician provider and earlier admission increased the risk of operative delivery. CONCLUSION: Later admission in labor (at 4 cm or greater cervical dilation) and management of perinatal care by certified nurse midwives in collaboration with obstetricians increased the rate of spontaneous vaginal delivery in low-risk women.

Adult↗