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Biomedical subjects

Keith A Eddleman

Publications and source records attributed to Keith A Eddleman.

9 recordsLinked to original sources
PubMed2006

Is misoprostol safe for labor induction in twin gestations?

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol to oxytocin for the induction of labor in twin gestations. METHODS: All twin gestations that underwent induction of labor with misoprostol or oxytocin during a 4-year period were identified from the Mount Sinai obstetrical database. Only twins > or = 34 weeks with a vertex presenting twin A were included. Labor and delivery characteristics, maternal complications and neonatal outcomes were compared between the two groups. RESULTS: Of 134 patients with twins, 57 initially received misoprostol and 77 received oxytocin. These groups had similar demographics, but women who received misoprostol had less cervical dilation (0.8 vs. 2.2 cm, p < 0.0001) and were less likely to be multiparous (19% vs. 44%, p = 0.003). There was a shorter length of induction to delivery (7.8 hours vs. 15.1 hours, p = 0.001) and a trend toward a lower cesarean section rate (16.9% vs. 31.6%, p = 0.06) in the oxytocin-only group. There were no cases of uterine rupture or maternal mortality in this series. There were no significant differences in neonatal outcomes between the two groups, but the sample size was underpowered to detect significant differences between the groups. CONCLUSIONS: Misoprostol and oxytocin both appear to be safe and efficacious for use in inductions of labor in twins in this limited retrospective investigation. The safety of these agents with regard to neonatal outcomes should be confirmed by larger studies.

Administration, Intravaginal↗
PubMed2006

Pregnancy loss rates after midtrimester amniocentesis.

OBJECTIVE: The purpose of this study was to quantify the contemporary procedure-related loss rate after midtrimester amniocentesis using a database generated from patients who were recruited to the First And Second Trimester Evaluation of Risk for Aneuploidy trial. METHODS: A total of 35,003 unselected patients from the general population with viable singleton pregnancies were enrolled in the First And Second Trimester Evaluation of Risk for Aneuploidy trial between 10 3/7 and 13 6/7 weeks gestation and followed up prospectively for complete pregnancy outcome information. Patients who either did (study group, n=3,096) or did not (control group, n=31,907) undergo midtrimester amniocentesis were identified from the database. The rate of fetal loss less than 24 weeks of gestation was compared between the two groups, and multiple logistic regression analysis was used to adjust for potential confounders. RESULTS: The spontaneous fetal loss rate less than 24 weeks of gestation in the study group was 1.0% and was not statistically different from the background 0.94% rate seen in the control group (P=.74, 95% confidence interval -0.26%, 0.49%). The procedure-related loss rate after amniocentesis was 0.06% (1.0% minus the background rate of 0.94%). Women undergoing amniocentesis were 1.1 times more likely to have a spontaneous loss (95% confidence interval 0.7-1.5). CONCLUSION: The procedure-related fetal loss rate after midtrimester amniocentesis performed on patients in a contemporary prospective clinical trial was 0.06%. There was no significant difference in loss rates between those undergoing amniocentesis and those not undergoing amniocentesis. LEVEL OF EVIDENCE: II-2.

Abortion, Spontaneous↗
PubMed2005

Long-term outcomes in multiple gestations.

Children born from a multiple gestation are at increased risk for cerebral palsy, learning disability, and language and neurobehavioral deficits. With the increased incidence of multiple pregnancies and use of assisted reproductive technology (ART), these issues are more commonly affecting parents. Long-term outcomes are a critical part of preconceptual and early pregnancy counseling for parents faced with a multiple gestation or considering ART, and the provider should be well versed on issues surrounding zygosity, gestational age, higher-order multiples, and the effects of options such as multifetal pregnancy reduction.

Female↗
PubMed2005

Impact of maternal age on obstetric outcome.

OBJECTIVE: To estimate the effect of maternal age on obstetric outcomes. METHODS: A prospective database from a multicenter investigation of singletons, the FASTER trial, was studied. Subjects were divided into 3 age groups: 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Multivariable logistic regression analysis was used to assess the effect of age on outcomes after adjusting for race, parity, body mass index, education, marital status, smoking, medical history, use of assisted conception, and patient's study site. RESULTS: A total of 36,056 women with complete data were available: 28,398 (79%) less than 35 years of age; 6,294 (17%) 35-39 years; and 1,364 (4%) 40 years and older. Increasing age was significantly associated with miscarriage (adjusted odds ratio [adjOR]2.0 and 2.4 for ages 35-39 years and age 40 years and older, respectively), chromosomal abnormalities (adjOR 4.0 and 9.9), congenital anomalies (adjOR 1.4 and 1.7), gestational diabetes (adjOR 1.8 and 2.4), placenta previa (adjOR 1.8 and 2.8), and cesarean delivery (adjOR 1.6 and 2.0). Patients aged 35-39 years were at increased risk for macrosomia (adjOR 1.4). Increased risk for abruption (adjOR 2.3), preterm delivery (adjOR 1.4), low birth weight (adjOR 1.6), and perinatal mortality (adjOR 2.2) was noted in women aged 40 years and older. CONCLUSION: Increasing maternal age is independently associated with specific adverse pregnancy outcomes. Increasing age is a continuum rather than a threshold effect.

Adult↗
PubMed2003

Multifetal pregnancy reduction and selective termination.

MPR and ST are important options for patients who have multifetal pregnancies. Both procedures have been shown to be technically safe and result in acceptable pregnancy loss rates and GAs at delivery. An important caveat is that these findings are observed in centers that have vast experience performing this type of procedure and should not be generalized to all centers. The authors believe that the good outcomes reported here and elsewhere are a result of having a relatively limited number of operators adhering to a strict common protocol and that they should not be generalized to all centers. Awareness of the ethical and psychological issues aids counseling of patients and their follow-up, but more information is needed in this area. Finally, it is the authors' hope that advances in ART will decrease the need for MPR procedures in the future.

Female↗
PubMed2002

Selective termination of anomalous fetuses in multifetal pregnancies: two hundred cases at a single center.

OBJECTIVE: The objective of this study was to summarize the outcome of 200 selective termination (ST) procedures performed at a single center. STUDY DESIGN: Two hundred patients underwent ST at the Mt Sinai Medical Center from 1986 to 2000. The following data were collected for each patient: indication for the ST, gestational age (GA) at the time of the procedure, starting and ending number of fetuses, which fetus(es) underwent ST (presenting vs nonpresenting), and GA at delivery or at spontaneous pregnancy loss less than 24 weeks. RESULTS: ST was performed on 164 sets of twins, 32 triplets, and 4 quadruplets. Median GA at the time of ST was 19.6 weeks. The presenting fetus was terminated in 91 (45.5%) cases. There were 8 (4%) unintended pregnancy losses less than 24 weeks, 4 of 164 (2.4%) in twins, 4 of 32 (12.5%) in triplets, and none of the 4 in quadruplets. The median GA at delivery in the remaining 190 patients was 37.1 weeks. One hundred sixty (84.2%) patients were delivered at >or=32 weeks' gestation. CONCLUSION: ST at our institution has an overall unintended pregnancy loss rate of 4%. The loss rate is almost 5-fold higher in patients carrying 3 or more fetuses (11.1%) than for those carrying twins (2.4%). ST is a reasonable alternative in multifetal pregnancies in which 1 or more fetuses have a significant abnormality.

Abortion, Spontaneous↗