Search PubMed⌕ Search

Biomedical subjects

J L Ecker

Publications and source records attributed to J L Ecker.

29 records · Page 2Linked to original sources
PubMed1996

Is there a benefit to episiotomy at spontaneous vaginal delivery? A natural experiment.

OBJECTIVE: Our purpose was to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at spontaneous vaginal delivery. STUDY DESIGN: We obtained data from 17,483 consecutive spontaneous vaginal deliveries and compared the yearly rates of episiotomy, lacerations, and potential confounders with linear regression and stratified analyses. RESULTS: Between 1976 and 1994 the use of episiotomy fell significantly (86.8% to 10.4%, R2 = 0.92, p = 0.0001). This change was associated with a fall in the rate of third- and fourth-degree lacerations (9.0% to 4.2%, R2 = 0.59, p = 0.0001) and a rise in the rate of intact perinea (10.3% to 26.5%, R2 = 0.68, p = 0.0001) and vaginal lacerations (5.4% to 19.3%, R2 = 0.77, p = 0.0001). These associations held in separate analyses stratified by parity and birth weight, except for the subgroup of nulliparous women with macrosomic infants. CONCLUSION: At our institution a large reduction in the use of episiotomy in spontaneous vaginal deliveries was associated with a significant reduction in perineal trauma in all groups of women except for nulliparous women with macrosomic infants.

Episiotomy↗
PubMed1993

Measurement of embryotoxic factors is predictive of pregnancy outcome in women with a history of recurrent abortion.

OBJECTIVE: To determine whether the production of embryotoxic factors in early pregnancy is predictive of pregnancy outcome in women with a history of two or more unexplained recurrent abortions. METHODS: Between July 1987 and June 1991, 450 nonpregnant women were evaluated for recurrent abortion. Embryotoxic factors were found in 328 of 346 women with an otherwise unexplained etiology. These women were given progesterone immunosuppressive therapy in a subsequent conception cycle, and embryotoxic factors were measured at 5 weeks' gestation. RESULTS: Data on embryotoxic factors and pregnancy outcome were available for 141 of 208 reported subsequent pregnancies. Of women still positive for embryotoxic factors, 40 had a repeat first-trimester spontaneous abortion whereas 16 delivered a viable infant; of women who no longer produced embryotoxic factors, only 11 had a repeat first-trimester abortion and 74 delivered a viable infant. CONCLUSIONS: The embryotoxic factor assay may be useful in predicting pregnancy outcome in women with a history of unexplained recurrent abortion. Further work is needed to evaluate the effectiveness of immunosuppression for this condition.

Abortion, Habitual↗
PubMed1992

Hirschsprung's disease: associated abnormalities and demography.

We here examine the demographic parameters of patients with Hirschsprung's disease. The study population includes all patients with histologically confirmed disease treated at the Children's Hospital Medical Center of Boston over the 25-year period extending from 1961 through the first quarter of 1986. There were 179 cases. Overall, children with Hirschsprung's disease were found less likely to be first born (P less than .01). This relationship was seen to persist irrespective of maternal age, maternal race, or type of disease. The implications of this finding are discussed. Overall, 22% of these children had one or more associated abnormalities involving the neurological, cardiovascular, urological, and gastrointestinal systems. Many of the disorders appeared to be related to neurocrestopathies. Frequent associations included Down's syndrome, defects in cardiac septation, tetralogy of Fallot, and Dandy-Walker syndrome. These conditions occurred more frequently than would have been predicted through chance alone. This study found no association between an increased maternal age and the occurrence of Hirschsprung's disease. This study also found that approximately 7% of the affected children had been born prematurely.

Abnormalities, Multiple↗
PubMed1992

Placenta increta complicating a first-trimester abortion. A case report.

Placenta increta complicating pregnancy in the first trimester is rare. A patient with risk factors for placenta increta required a hysterectomy to control a hemorrhage after a first-trimester abortion. Pathologic study confirmed the preoperative diagnosis of placenta increta.

Abortion, Induced↗
PubMedDate not supplied

Pregnancy outcome following ultrasound-detected fetal cardiac activity in women with a history of multiple spontaneous abortions.

OBJECTIVE: To determine whether women with two or more previous spontaneous abortions of unknown etiology, by conventional testing criteria, have a different rate of subsequent fetal loss than controls after ultrasonic documentation of fetal cardiac activity. METHODS: Medical records were reviewed from 185 women with spontaneous abortion of unknown etiology. Of these women, 91.9% were found to have evidence of cellular immunity to trophoblast and were treated with progesterone for immunosuppression. Ultrasound evaluation was obtained at 5-6 weeks' gestation to document fetal cardiac activity. A control group of 63 women was also studied. All women were followed for pregnancy outcome. RESULTS: A total of 248 pregnancies were identified from the 185 study patients with multiple spontaneous abortions. Fetal cardiac activity was visualized by ultrasound in 209 pregnancies from 171 study subjects; of these, the outcomes of 208 pregnancies were known. The rate of spontaneous abortion after ultrasound documentation of fetal cardiac activity was 22.7%. Neither maternal age nor number of previous losses was associated with an increased incidence of spontaneous abortion following documentation of fetal cardiac activity. The rate of spontaneous abortion in the control group after documentation of fetal cardiac activity was 3.3%. CONCLUSION: These data may help clinicians give couples who have experienced recurrent pregnancy loss a more realistic prognosis for pregnancy success once fetal cardiac activity has been confirmed.

Abortion, Habitual↗