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Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 55 records · Page 3Linked to original sources
PubMed1997

Patterns of uterine activity. Using oxytocin after intracervical PGE2.

OBJECTIVE: To compare patterns of uterine activity from low-dose oxytocin begun immediately or six hours after intracervical placement of prostaglandin E2 (PGE2) gel for the induction of labor. STUDY DESIGN: A total of 50 nonlaboring women at term with an unfavorable cervix (Bishop score < or = 4) were given a 0.5-mg dose of PGE2 gel. Each was then randomized either to be observed or to receive a low dose of oxytocin (2 mU/min, increased by 2 mU/min at 30-minute intervals, as necessary). After the six-hour observation, the patient was reexamined, and a low dose of oxytocin was either begun or continued. An adequate sample size (21 per group) was calculated for evaluating uterine activity changes. Comparisons were made using chi 2 testing, Student's t test and analysis of variance, as appropriate. RESULTS: There were no differences between the two groups in maternal race, gestational age, predose Bishop score, predose uterine activity or indication for induction. Uterine contractions became more frequent (P < .01) and were judged to be more intense (P < .02) and earlier when oxytocin was used immediately after PGE2 placement. No uterine hyperstimulation or abnormal fetal heart rate pattern was observed that required discontinuation of the oxytocin. The percentages of cases delivering vaginally within 24, 36 and 48 hours were greater when oxytocin was begun immediately in nullipara (P < .01). CONCLUSION: Low-dose oxytocin may be started immediately after instilling intracervical PGE2, with shortened time until the onset of adequate contractions.

Administration, Intravaginal↗
PubMed1997

Midtrimester pregnancy termination for fetal malformations. Use of intravaginal prostaglandin E2.

OBJECTIVE: To compare outcome differences and responses to treatment in pregnancies complicated by either major fetal malformations or previous fetal death in the second trimester. STUDY DESIGN: Data were analyzed from a computerized perinatal database and individual hospital records for singleton gestations between 14 and 23 weeks undergoing labor induction with prostaglandin E2 (PGE2) suppositories (20 mg intravaginally every three to five hours). RESULTS: Between January 1993 and June 1995, 65 pregnancies underwent induction of labor for either a lethal fetal malformation (38) or death (27). As compared with the fetal death group, the malformation group required more suppositories (median 4, range 1-10, versus median 3, range 1-6; P < .05) and needed a greater total dosage (77.5 +/- 38.5 mg versus 61.8 +/- 37.8 mg, P < .05). The mean time from initiation of treatment until delivery was two hours longer in the malformation group. There were no significant differences between the two treatment groups in incidence of maternal side effects or of retained placentas requiring operative intervention. CONCLUSION: Patients who undergo second-trimester induction of labor for major fetal malformations using intravaginal PGE2 should be counseled that the dosage of the drug is greater and that labor may last longer than in pregnancies complicated by a previous fetal death.

Abortion, Induced↗
PubMed1996

Placental transfer of milrinone in the nonhuman primate (baboon).

Milrinone is an inotropic agent for short-term intravenous use in the management of congestive heart failure. The purpose of this article is to question the previously reported lack of transplacental transfer of milrinone. Loading and continuous intravenous doses, considered to be therapeutic in humans, were administered to four near-term baboons. Transplacental passage was documented, with a maternal/fetal serum ratio of approximately 4:1 found during the 3 hours of infusion.

Animals↗
PubMed1996

Clinical commentary: the bromocriptine (Parlodel) controversy and recommendations for lactation suppression.

Mounting concerns about bromocriptine (Parlodel) and rare cardiovascular and cerebrovascular accidents have prompted the manufacturer to remove the drug from the market for use in postpartum lactation suppression. No drug is available now or will be in the forseeable future for the indication. This change in prescribing practice should alert the physician to counseling the expectant mother about the merits of breast feeding and about simple, non-pharmacologic methods of suppressing milk production.

Breast Feeding↗
PubMed1996

Periconceptional folate intake and neural tube defects.

Approximately 50% of neural tube defects may be folate-preventable and perhaps even more in other countries where prevalence is high. The Public Health Service has issued the recommendation that all women of childbearing age in the United States who are capable of becoming pregnant should consume 400 micrograms of folic acid/day for the purpose of reducing this risk. Ways in which a reproductive age woman could achieve this goal include: 1) fortifying a food sample with folic acid, 2) consuming supplements containing at least 400 mcg of folic acid, or 3) increasing nutrient intake by eating foods rich in folate. Advantages of consuming foods high in folate content are that it is a natural behavior and consistent with other dietary recommendations. However, this method is dependent upon a proper diet, and equivalencies of conjugated (dietary form) vs. unconjugated (in supplements) folate are unknown. The benefit of a supplementation policy is that the appropriate group can be targeted as pregnancies are planned, whereas primary limitations to taking a supplement would be compliance and most cases in need would not be reached. The advantage of fortification is that it is likely to reach everyone before conception, while the major disadvantage is that nontargeted populations will also receive more folic acid. Adequate consumption of folic acid should begin before and continue during at least the first 4 weeks after conception when the fetal neural tube is being formed. Standard methods of screening for neural tube defects should continue during pregnancy. The risk of a recurrent neural tube defect is 2-3%, and a higher periconception daily intake of folic acid (4 mg per day) is recommended.

Adolescent↗
PubMed1996

Refinements in performing a cesarean delivery.

Several refinements in performing a cesarean delivery have been proposed in recent years. The surgeon is now more aware of the potential of HIV virus exposure and is inclined to use techniques to minimize contact with sharp objects. Wide incisions of the skin and fascia are encouraged for greater ease in delivering the fetus. When possible, a low transverse uterine incision is attempted to allow for an improved chance of undergoing successful labor with any subsequent pregnancy. Spontaneous delivery of the placenta may reduce blood loss and decrease the chance of postoperative endometritis. Single layer closure of the uterus without closure of the peritoneum is as safe and effective as a two-layer closure. Not closing the visceral or parietal peritoneum appears to be an acceptable alternative. Superficial wound disruption may be minimized by either closing large, nondraining subcutaneous spaces or using continuous drainage. Limitations with descriptive experiences and randomized clinical trials should be appreciated when translating this information into routine surgical practice.

Cesarean Section↗
PubMed1996

Successful urgent cerclage in a quadruplet gestation.

Pregnancies complicated by quadruplets are rare but at high risk for premature cervical dilation, premature deliveries, and increased perinatal mortality. This report presents a case of a patient carrying quadruplets whose cervix became 4 cm dilated at 21 weeks even though there were no reported uterine contractions. Despite bed rest and combination tocolytic therapy, the cervix dilated to 6 cm and the membranes protruded. Described here are refinements of an Olatunbosun technique to successfully perform the cerclage. Labor occurred at 32 weeks, and a cesarean delivery was performed before the transvaginal removal of the cerclage. The four appropriately-grown fetuses adjusted well in the intensive care nursery.

Adult↗
PubMed1996

Blood pressure monitoring during pregnancy. Accuracy of portable devices designed for obese patients.

OBJECTIVE: To compare the accuracy of three commercially available blood pressure monitoring devices having cuffs placed at different anatomic sites on obese pregnant women with large arms. STUDY DESIGN: Fifty-five obese pregnant women (body mass index > 27.3) were eligible for participation; each had an upper arm circumferences > 35 cm. The three different portable devices compared had cuffs that fit easily around either the index finger, wrist or large arm. Two recordings using each device were compared with those obtained simultaneously using a well calibrated monitor. RESULTS: Systolic, diastolic and mean arterial pressure recordings did not correlate between the monitor and devices with the cuff around the finger (r2 = .17, .17, .22), wrist (.30, .24, .33) or large arm (.44, .26, .40). The percentages of measurement differences within 5 mm Hg for the systolic, diastolic and mean arterial pressure were low for the device with the cuff around the finger (11.0%, 25.5%, 23.6%), wrist (33.0%, 46.4%, 35.5%) or large arm (38.5%, 29.4%, 46.7%). CONCLUSION: Despite their commercial appeal, none of these portable blood pressure monitoring devices was accurate for use by obese pregnant patients with large arms.

Adolescent↗
PubMed1996

Managing pregnancy-related nocturnal nasal congestion. The external nasal dilator.

OBJECTIVE: To assess the efficacy of an over-the-counter mechanical nasal dilator during sleep in pregnant women with nasal congestion. STUDY DESIGN: Pregnant women with symptoms of nocturnal nasal congestion not attributed to allergies or "cold" symptoms were randomized in a double-blind manner to receive either a spring-loaded device or placebo device without a spring. Each patient assessed breathing and sleep quality for a three-day baseline and three-day treatment period. A 10-question diary was utilized to assess breathing, ease of falling asleep, sleep quality, and continuity and depth of sleep. Averaged scores for each question were computed for baseline and treatment periods, and differences were calculated. Statistical analyses were by the sign test, Fisher's exact test and Student's test. RESULTS: Thirty-four (21%) of 160 screened patients were enrolled into the study; 24 (15%) completed the study. All agreed to being assigned to receive either the spring-loaded device (n = 12) or a placebo (n = 12) device. Responses to 8 of the 10 questions favored the former as compared with the placebo (P = .05, sign test). Moreover, patients treated with the spring-loaded device gave more favorable responses to the question, "Overall, compared with most nights, how easy was your breathing through-out last night?" (P = .02, t test). CONCLUSION: Use of this drug-free external nasal dilator improved the ease of breathing among patients with pregnancy-related nocturnal congestion.

Adult↗
PubMed1995

Effects of intracervical prostaglandin E2 on fetal heart rate and uterine activity patterns in the presence of oligohydramnios.

OBJECTIVE: Our purpose was to compare fetal heart rate patterns and uterine activity before and after preinduction prostaglandin E2 administration in the presence or absence of oligohydramnios. STUDY DESIGN: In a retrospective case-controlled review we examined cases in which prostaglandin E2 (Prepidil) was inserted intracervically for gravid women requiring an induction of labor in the presence of either oligohydramnios (amniotic fluid index < or = 5.0) or adequate fluid (amniotic fluid index 5.1 to 23.9). Uterine activity and fetal heart rate tracings that were begun 1 hour before and continued for 6 hours after dosing were interpreted without knowledge of amniotic fluid volume. RESULTS: Cases in the oligohydramnios (n = 51) and adequate fluid (n = 49) groups were the same for maternal age, race, parity, gestational age, and predose Bishop score. Patients with oligohydramnios had more high-amplitude contractions in the first hour after dosing (9.0 +/- 1.2 vs 6.1 +/- 0.9, p < 0.05), but there were no significant differences in the frequency or duration of contractions during the subsequent 5 hours. Uterine hyperstimulation was not seen, and there were no differences in the frequency of variable or late fetal heart rate decelerations. CONCLUSION: For pregnancies undergoing preinduction cervical ripening with intracervical prostaglandin E2, the presence of oligohydramnios was not associated with a greater risk of fetal heart rate decelerations, although contractions were more common during the first hour after dosing.

Adult↗
PubMed1995

Multiple nuchal cord entanglements and intrapartum complications.

OBJECTIVE: Our purpose was to evaluate the outcomes of pregnancies complicated by a multiple (double, triple, or quadruple) nuchal cord entanglement. STUDY DESIGN: Computerized data from our University Hospital perinatal database were reviewed between 1990 and 1994. Only singleton, vertex, and term pregnancies undergoing labor were analyzed. Patients with active perinatal complications were eliminated to reduce bias. Pregnancies with infants with either a single or no nuchal cord entanglement served as comparison groups. A comparison of frequencies in the three groups was by chi 2 testing and a comparison of means by a two-tailed Student t test and analysis of variance. RESULTS: Of the 8565 deliveries, the frequency of two or more cord entanglements at delivery was 3.8%. Compared with a single or no cord entanglement, pregnancies with a multiple entanglement were more likely to exhibit an abnormal fetal heart rate pattern during advanced labor (p < 0.001) and to require low or midforceps application (p < 0.001). The study infants were also more likely to have meconium (p = 0.013), a low 1-minute Apgar score (p < 0.001), and an umbilical artery pH < or = 7.10 (odds ratio 2.2, p = 0.013) than the controls. Rates of abruptio placentae, cesarean delivery, and 5-minute Apgar scores < 7 were no more common in the multiple entanglement than the control groups. CONCLUSION: A multiple nuchal cord entanglement was associated with a greater risk of meconium, an abnormal fetal heart rate pattern during advanced labor, the need for operative vaginal delivery, and mild umbilical artery acidosis at birth; however, there was no added risk of an adverse neonatal outcome.

Acidosis, Respiratory↗
PubMed1995

Intravenous magnesium sulfate for premature labor: comparison between twin and singleton gestations.

Premature labor occurs frequently in twin gestations, and intravenous magnesium sulfate is commonly prescribed for tocolysis. The purpose of the present investigation was to determine the efficacy and safety of intravenous magnesium sulfate tocolysis in twin gestations using dosing regimens reported for singletons. Outcomes were compared between cases of singleton gestations eligible for tocolysis and admitted immediately before and after each twin case. The standard loading dose in both groups was 4 to 6 g intravenously with a maintenance dose of 1 to 3 g/hr. Data were compared using unpaired t tests or chi-square analysis where appropriate. The 24 evaluable cases of twins were similar in demographics to a similar cohort of 48 singletons. Frequencies of side effects and durations of therapy were the same between the two groups. The number of days from beginning therapy until delivery was highly variable but not significantly different for the twin and singleton groups (13.5 +/- 14.8 vs 20.9 +/- 20.1 days, mean +/- SD). No significant differences were found between the twin and singleton groups in delays in delivery during the first 72 hours (16 [66.7%] vs 35 [72.9%]) and by the 33rd completed week (10 [41.6%] vs 25 [52.1%]). In conclusion, guidelines for prescribing intravenous magnesium sulfate to inhibit premature labor in singletons are equally safe and effective for twin gestations.

Adult↗
PubMed1995

Influence of spontaneous or induced labor on delivering the macrosomic fetus.

Fetal macrosomia is a known intrapartum risk factor for fetal injury and maternal morbidity. The purpose of this study was to review our experience with macrosomic fetuses in nondiabetic pregnancies and compare perinatal outcomes between those whose labor had been spontaneous or induced. Between January 1989 and December 1991, the 186 pregnancies of infants with birthweights greater than 4000 g (4001 to 5131 g) underwent labor that had been induced (46) or spontaneous (140). Cesarean delivery was more common after induced than spontaneous labor (11 [23.9%] vs 14 [10.0%]; P < 0.03) regardless of parity or gestational age. Frequencies of shoulder dystocia, 1-minute Apgar scores less than 7, and abnormal umbilical blood gas determinations were not different between the two groups. We conclude that spontaneous rather than induced labor is associated with a lower chance of cesarean delivery among those fetuses with birthweights 4000 g or more.

Adult↗
PubMed1995

Fetal movement monitoring.

Monitoring fetal movement serves as an indirect measure of central nervous system integrity and function. The coordination of whole-body movement, which requires complex neurologic control, is similar to that of the preterm newborn infant. Short-term observations of the fetus are best performed using real-time ultrasound imaging or Doppler ultrasound. Daily fetal movement charting by the compliant patient is a worthwhile adjunct in determining the frequency of fetal surveillance tests in the office and in predicting abnormal FHR patterns and perhaps impending stillbirth. Monitoring has its greatest value when placental insufficiency is long-standing, and its routine role in low-risk pregnancies requires further clinical investigation. The presence of a vigorous fetus is reassuring. Perceived inactivity requires reassessment of any underlying antepartum complication and more precise evaluation by FHR testing or real-time ultrasonography before delivery is considered.

Central Nervous System↗
PubMed1995

A statewide, toll-free telephone service to improve obstetric care.

The University of Oklahoma Health Sciences Center began in 1993 to provide a statewide, toll-free telephone service for pregnancy counseling to primary care physicians. The service was available 24 hours each day, and responses were made by the on-call maternal-fetal medicine specialist. This report summarizes our first full year of operation. Inquiries came from 34 (63%) of the state's 54 counties having physicians who provide obstetric care. One hundred twenty-eight physicians made 523 inquiries (median 3, range 1-15). Information was sought about prenatal genetic disorders, risks from drugs, exposure to infection, environmental hazards, and active obstetric or medical complications. Funds from targeted ultrasounds, genetic amniocenteses, more detailed counselling, and maternal transfers provided support for this expanding educational resource.

Female↗
PubMed1995

Umbilical cord length and acid-base balance at delivery.

An abnormally short or long umbilical cord is associated with a greater risk of cord compression, variable fetal heart rate decelerations and fetal demise. The purpose of the present investigation was to determine whether any relation exists between an abnormal length of the umbilical cord and acid-base imbalance at delivery. Cord lengths were measured routinely in 3,019 consecutive pregnancies undergoing labor beyond 34 weeks. Short cords (13-35 cm) were found in 61 (2.0%) cases and long cords (80-121 cm) in 112 (3.7%) cases. Umbilical blood pH and base deficit values averaged the same for those pregnancies with short (7.35 +/- 0.09 and 3.1 +/- 2.7 mEq/L, mean +/- SD), normal length (7.36 +/- 0.03 and 3.8 +/- 1.7, mEq/L) and long (7.34 +/- 0.06 and 3.7 +/- 3.1 mEq/L) cords. A blood pH < 7.20 was very uncommon in the presence of a short (two cases, 3.3%) or long (five cases, 4.5%) cord and was accompanied by an abnormal fetal heart rate pattern, such as severe variable decelerations or bradycardia. Finding an abnormally short or long umbilical cord at birth is not by itself associated with an increased risk of acid-base imbalance at delivery and does not require routine cord blood gas determination.

Acid-Base Imbalance↗