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Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 37 records · Page 2Linked to original sources
PubMed1999

Uterine rupture after use of a prostaglandin E2 vaginal insert during vaginal birth after cesarean. A report of two cases.

BACKGROUND: Prostaglandin E2, when used for cervical ripening, often initiates labor. Single dosing and ease of removal contribute to the common use of a commercially available prostaglandin E2 vaginal insert. We describe two cases of uterine rupture among 57 pregnancies undergoing attempted vaginal birth after cesarean section. CASES: Two cases of women attempting vaginal birth after a single low transverse cesarean section were treated with the insert either at 41 weeks, 4 days, or 39 weeks, 3 days, for postdatism or preeclampsia. Signs of uterine rupture included persistent suprapubic pain and repetitive fetal heart rate variable decelerations followed by bradycardia. Infant outcomes were favorable, and tears along the prior low transverse uterine scar were repaired without additional morbidity. CONCLUSION: This prostaglandin compound is not exempt from being associated directly or indirectly with uterine rupture and requires informed consent and continuous monitoring.

Administration, Intravaginal↗
PubMed1999

Projections of population-based twinning rates through the year 2100.

OBJECTIVE: To present the first compilation of population-based twinning rates published after the year 1990 and to project population-based twinning rates through the year 2100. STUDY DESIGN: We searched the Internet-based MEDLINE database for articles published after 1990 in which population-based twinning rates were described. We used population-based data from national statistical authorities from Australia, Austria, Canada, Finland, Hong Kong, Israel, Japan, Norway, Singapore and Sweden, published by Y. Imaizumi in a recent article. U.S. figures were based on data from the National Center for Health Statistics. Annual growth rates of twinning were calculated and graphed, making the assumption that these rates would remain constant throughout the next century. RESULTS: Our report presents the most recent population-based twinning rates. When projected through the year 2015, twinning rates reach figures that could best be described as derived from a Jules Verne novel: Sweden, in this model, would have four times more twin than singleton births. CONCLUSION: We strongly suggest that physicians reexamine their patterns of prescribing ovulation-inducing agents, which carry a greatly increased risk of multiple pregnancy.

Adult↗
PubMed1999

Low backache during pregnancy. Acute hemodynamic effects of a lumbar support.

OBJECTIVE: To determine whether a commercially available elastic/Velcro lumbar and abdominal support (Mother-To-Be, CMO, Inc., Barberton, Ohio) affects the hemodynamics of the fetus and pregnant woman. STUDY DESIGN: Healthy volunteers with low backache at 24-36 weeks' gestation were sought from our obstetric clinic population. The fetal heart rate (FHR), maternal blood pressure and maternal cardiac output were monitored for 20-minute intervals before, during and after placement of the support while standing and sitting. A sufficient number of subjects was used to detect a difference of 10% in cardiac output. RESULTS: Twenty-five women were enrolled between 24 and 36 weeks' gestation. No significant changes were encountered in the FHR baseline or beat-to-beat variability during placement of the support. The few FHR decelerations were isolated and not attributable to the support. The maternal systolic, diastolic and mean arterial blood pressures were unaffected by the support. The right-sided and left-sided cardiac outputs were unchanged during the monitoring periods. Each woman, when questioned two weeks later, reported improvement in back discomfort while sitting and standing. CONCLUSION: This elastic/Velcro lumbar and abdominal support, available to relieve low backache, did not acutely affect the hemodynamics of the fetus and mother.

Adult↗
PubMed1998

Effectiveness of prostaglandin E2 intracervical gel (Prepidil), with immediate oxytocin, versus vaginal insert (Cervidil) for induction of labor.

OBJECTIVE: Our purpose was to compare the effectiveness of labor induction with use of prostaglandin E2 either as an intracervical gel (Prepidil), with immediate oxytocin, or as a sustained-release vaginal insert (Cervidil) with subsequent oxytocin as needed. STUDY DESIGN: Hospitalized patients at >/=37 weeks' gestation requiring labor induction and having an unfavorable cervix (Bishop score </=6) were randomly assigned to receive either Prepidil or Cervidil. Oxytocin was begun immediately after Prepidil placement or 30 minutes after removal of the Cervidil insert if needed. RESULTS: Of the 150 patients, there were no differences in demographics and eventual pregnancy outcomes between the Prepidil group (n = 77) and the Cervidil group (n = 73). Those pregnancies receiving the Prepidil-immediate oxytocin regimen were delivered sooner than those receiving the Cervidil among nulliparous (11.3 +/- 7.3 hours vs 25.2 +/- 12.5 hours, P <.001) and multiparous (8.4 +/- 7.8 hours vs 18.4 +/- 7.2 hours, P <.001) women. The mean cost savings, which favored the Prepidil-immediate oxytocin regimen, was $458 (range $204 to $630) per patient. CONCLUSION: Compared with Cervidil, the Prepidil-immediate oxytocin regimen resulted in a shorter induction-to-vaginal delivery interval and in more hospital cost savings without increasing adverse outcomes.

Administration, Intravaginal↗
PubMed1998

Pre-eclampsia and induction of labor: a randomized comparison of prostaglandin E2 as an intracervical gel, with oxytocin immediately, or as a sustained-release vaginal insert.

OBJECTIVE: Our purpose was to compare the efficacy of commercial prostaglandin E2 products, in combination with oxytocin, for the initiation of labor among pregnancies with pre-eclampsia. STUDY DESIGN: Patients with pregnancy-induced hypertension and with either proteinuria or other end-organ damage were enrolled if they had an unfavorable Bishop score (</=4) and were eligible to undergo labor. Each was randomly assigned to receive prostaglandin E2 either as a 0. 5-mg intracervical gel (Prepidil) or as a 10-mg controlled-release vaginal insert (Cervidil). Oxytocin was begun either immediately after instillation of the gel or was delayed until after removal of the insert. RESULTS: Of the 70 patients, there were no differences between the Prepidil (n = 34) and the Cervidil (n = 36) groups in maternal demographics, gestational age, parity, and predose Bishop score. There was a mean 14.3-hour difference in the duration from beginning therapy until vaginal delivery in the Prepidil group than in the Cervidil group (11.5 +/- 2.3 hours vs 25.8 +/- 6.9 hours, P <. 001). This time difference, which favored use of Prepidil-immediate oxytocin, remained significant after parity (nulliparous: 20 hours, P <.005; multiparous: 12 hours, P <.01) and gestational age were controlled (preterm: 15.5 hours, P <.01; term: 13.3 hours, P <.01). CONCLUSION: Use of combined intracervical prostaglandin E2 gel-immediate oxytocin therapy was more effective in shortening the induction-to-vaginal delivery time than use of a controlled-release prostaglandin E2 vaginal insert.

Administration, Intravaginal↗
PubMed1998

Placebo-controlled comparison between a single dose and a multidose of betamethasone in accelerating lung maturation of mice offspring.

OBJECTIVE: Our purpose was to determine, in a placebo-controlled manner with a mouse model, whether a multidose of betamethasone is more beneficial than a single dose in accelerating fetal lung maturation. STUDY DESIGN: Ninety gravid CD-1 mice were randomly assigned to 1 of 3 groups (n = 30) to receive either a placebo (0.25 mL subcutaneously) or betamethasone (0.1 mg subcutaneously) as a single dose on gestational day 14 or as a multidose twice daily on gestational day 14 and 15. Ten pregnancies in each group were terminated at gestational day 16.5 to observe the neonatal breathing pattern (scale 0 to 5; 5 is unlabored breathing) and the lung histologic findings (scale 0 to 5; 5 is alveolar budding). The lungs of the offspring belonging to the remaining 20 pregnancies in each group were removed and weighed at postnatal day 1, 3, 5, or 120. RESULTS: Fetuses exposed to a multidose of betamethasone displayed a higher breathing score at gestational day 16.5 than either to a single dose or to the placebo (mean score 4.6 vs 3.8 or 1.3; P <. 001). Alveolar development was greater after exposure to a multidose of betamethasone than after a single dose or after a placebo (mean score 4.4 vs 3.5 or 1.6; P <.001). The lung weights at gestational day 16.5 were less after a multidose of betamethasone than after a single dose of either betamethasone or a placebo (18.3 +/- 1.0 g vs 21.4 +/- 1.3 g or 23.3 +/- 1.3 g; P <.02). The lung/body weight ratio was similarly affected. This reduced weight of the lungs persisted postnatally into adulthood. CONCLUSIONS: With a CD-1 mouse model, a multidose of antenatal betamethasone accelerated fetal lung maturation more than after a single dose but was accompanied with a decrease in lung weight that persisted into adulthood.

Animals↗
PubMed1998

Connective tissue disorders and pregnancy. Recommendations for prescribing.

This report summarizes experience with drugs prescribed for women with connective tissue disorders who either are anticipating childbearing, are pregnant or are breast-feeding. Principles of maintenance therapy are the same as when nonpregnant. Comparative trials of drugs during gestation are uncommon because of a lack of sufficient case numbers. It is difficult to distinguish between any additional risks from the medication, from any other drug and from the underlying disease. Symptoms of pregnancy may mimic side effects or toxic reactions to certain drugs. Each drug crosses the placenta, and any additional risk of spontaneous abortion, malformation or stillbirth is either negligible or unproven. Potential fetal problems with long-term intrauterine exposure to these drugs may include pancytopenia, immunosuppression, craniofacial abnormalities or restricted growth. These agents are transferred into breast milk in small quantities. Descriptions are provided of perinatal outcomes after in utero exposure to prednisone, aspirin, other nonsteroidal antiinflammatory drugs, antimalarials, gold salts, methotrexate, cyclophosphamide and azathioprine.

Adult↗
PubMed1998

Inducing labor with a sustained-release PGE2 vaginal insert. Experience at a community hospital.

OBJECTIVE: To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital. STUDY DESIGN: Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought. RESULTS: Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert. CONCLUSION: This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.

Administration, Intravaginal↗
PubMed1997

Impact of multiple antenatal doses of betamethasone on growth and development of mice offspring.

OBJECTIVE: Our purpose was to determine in a randomized, placebo-controlled manner whether multiple antenatal doses of betamethasone affect long-term growth and development of exposed mouse offspring. STUDY DESIGN: Sixty pregnant CD-1 mice received either two, four, or eight antepartum doses of 0.1 mg betamethasone or placebo. Perinatal outcomes, growth, and development of the offspring were compared in a blinded manner. Variables were compared by analysis of variance or chi 2 testing. RESULTS: Betamethasone-exposed subjects gained less weight during pregnancy and were delivered of fewer live pups, with fewer male survivors and lower birth weights. These trends were dose related. Growth measurements were similar after the neonatal period. No differences in functional development and physical maturation in the offspring were noted. The reproductive capability, perinatal outcomes, and growth and development of the second-generation offspring were unaffected by betamethasone exposure. CONCLUSION: Multiple antenatal dosings of betamethasone, reaching toxic levels, did not have an impact on the long-term growth and development of the surviving mouse offspring.

Animals↗
PubMed1997

A placebo-controlled comparison between betamethasone and dexamethasone for fetal maturation: differences in neurobehavioral development of mice offspring.

OBJECTIVE: Our purpose was to determine whether antenatal betamethasone or dexamethasone is the preferred drug by use of neurobehavioral development assessment of exposed mice offspring. STUDY DESIGN: Thirty adult CD-1 mice were randomly assigned to one of three groups (n = 10) to be administered a single subcutaneous dose of either a placebo (0.9% sodium chloride), betamethasone (0.10 mg), or dexamethasone (0.10 mg) on day 14 (74%) of gestation. The offspring then performed a battery of sensory, motor, motivational-anxiety, cognitive, and social tasks. Data were compared with use of analysis of variance, Kruskal-Wallis, or chi2 testing where appropriate. RESULTS: The offspring from the three treatment groups were indistinguishable at birth. Dexamethasone exposure induced a brief developmental delay. Separation anxiety was increased in the dexamethasone-exposed group in the perinatal period, whereas exposure to both corticosteroids decreased anxiety in the juvenile period, continuing into adulthood among male betamethasone-exposed mice. Selective enhancement of a memory process occurred in betamethasone-exposed mice, whereas dexamethasone exposure resulted in a decrement. Socialization as to place preference while awake and asleep varied among the three treatment groups. Corticosteroid treatment did not induce significant changes in sensory, motor, motivation, and learning performances or in reproductive capability and progeny development. CONCLUSION: Subtle differences in offspring performances of neurobehavioral development tasks favored antenatal betamethasone rather than dexamethasone. This finding, along with the knowledge that dexamethasone is less potent in accelerating lung maturity in the fetal mouse, suggests that betamethasone may be the preferred corticosteroid to use when human preterm delivery is imminent.

Animals↗
PubMed1997

Double-blind, placebo-controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy.

OBJECTIVE: To determine whether ranitidine (Zantac) taken once or twice daily is effective for relieving symptoms of gastroesophageal reflux among pregnant women who had failed conservative measures. METHODS: Volunteers with heartburn despite antacids were sought among our obstetrics clinic population for this double-blind, placebo-controlled, triple crossover trial. After a baseline week, 20 patients were randomized to receive the three following weekly regimens: ranitidine 150 mg twice daily, placebo in the morning and ranitidine 150 mg in the evening, or placebo twice daily. Daily scores on symptom diaries, global assessments, and number of antacids taken were compared among the 18 patients completing the study. RESULTS: The twice-daily dosage of ranitidine was the only regimen found to reduce heartburn symptoms when compared with the baseline (P < .001) or a placebo (P < .01). Compared with ranitidine taken once daily, the twice-daily dosing prompted less need for antacid tablets compared with the placebo (P < .05 versus P > .05) and to the baseline (P < .001 versus P < .05). The average reduction of heartburn severity using twice-daily ranitidine was 55.6% when compared with baseline (95% confidence interval [CI] 34.8%, 76.5%) was 44.2% when compared with placebo (95% CI 15.4%, 72.9%). CONCLUSION: This study indicates the efficacy of ranitidine 150 mg taken twice daily, rather than once daily, for relief of gastroesophageal reflux symptoms during pregnancy.

Cross-Over Studies↗
PubMed1997

Off-label prescribing during pregnancy.

Obstetricians frequently prescribe drugs for indications other than those on the product label. Reasons for such off-label use during pregnancy include prevention of repetitive abortion, inhibition of premature labor, reduction of fetal or neonatal infection, reduction in development of preeclampsia and its complications, and ripening of the cervix or induction of labor. A physician has a legal right to prescribe for off-label indications despite regulatory, manufacturer, and cost constraints. Such prescribing habits would not be considered experimental if based on sound scientific evidence. Adequate and well-controlled studies are difficult, however, to perform during pregnancy. Evidence of widespread use and support from another qualified clinician are methods of justifying off-label prescribing. Each patient is entitled to know why she and her fetus would benefit from the treatment and whether any unnecessary risk is anticipated. Legible documentation of these discussions in the medical records is important.

Drug Approval↗
PubMed1997

Nuchal cord entanglements and gestational age.

The purpose of this observational study was to investigate the relation between nuchal cord entanglements and gestational age. Computerized data from our hospital perinatal database were reviewed between January 1990 and December 1994. Data from all deliveries > or = 20 weeks' gestation underwent either a Cochran-Mantel test for trend or Chi-square testing where appropriate. Of the 13,895 singleton deliveries, the finding of an entanglement increased significantly from 5.8% at 20 weeks to 29.0% at 42 weeks' gestation. The frequencies increased linearly, regardless of whether the entanglement involved a single loop (p < 0.001) or multiple loops (p < 0.002). The risk of an antepartum stillbirth was not increased in the presence of a nuchal cord entanglement, even after controlling for other risk factors. These normative data should serve as a reference for prenatal ultrasound examinations and for prospective studies intended to evaluate the predictive value of reporting this finding prenatally.

Female↗
PubMed1997

Prenatal use of medications by women giving birth at a university hospital.

Medication use during pregnancy has changed over time because of various factors: new products have been marketed, concerns have arisen regarding safety and efficacy, public education has increased, and some prescription medications have been granted nonprescription status by the Food and Drug Administration. The purpose of this investigation was to determine overall medication and substance use by prenatal patients whose infants were delivered at our tertiary university hospital. Within 96 hours after delivery, 100 women were evaluated by a personal interview and medical record review. The medications most commonly used during pregnancy were vitamins, analgesics, calcium and iron preparations, and antibiotics. The mean numbers of medications consumed during the second and third trimesters (3.32 +/- 1.87 and 4.13 +/- 2.46) were significantly higher than the mean number taken before pregnancy (2.65 +/- 1.95). Over-the-counter medications accounted for 54% of the total products taken during pregnancy. Percentages of women using caffeine, tobacco, alcohol, and illicit drugs decreased during pregnancy.

Adult↗
PubMed1997

Chronic medical disorders during pregnancy. Guidelines for prescribing drugs.

This report summarizes experience with representative drugs used to treat patients with medical disorders existing before pregnancy. Preconception counseling is ideal for determining whether drug therapy needs to be continued or altered. Focusing on the underlying disorder or morbid co-conditions, not the drug alone, may explain any additional hazards to the fetus. Avoiding multiple medications and selecting that which is presumably safest are encouraged. The best means of monitoring the safety and efficacy of therapy should be determined. Few drugs and their metabolites are linked to either specific birth defects or life-threatening problems, but their effects on the developing fetal circulation and central nervous systems are difficult to predict. Despite attempts to minimize fetal exposure, an increase in either the daily dose or duration of drug therapy may be necessary for optimal results. Although no drug is absolutely safe, the healthiest mother is most likely to deliver the healthiest infant.

Chronic Disease↗