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Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 91 records · Page 5Linked to original sources
PubMed1992

Portable blood pressure monitoring for borderline or mild hypertension during pregnancy.

Several advantages are apparent in the use of self-monitored or automatic ambulatory blood pressure monitoring by pregnant patients who appear to have borderline or mild hypertension. Home recordings, combined with conventional office measurements, can give a more accurate picture of the patient's dynamic blood pressure. Blood pressures are often lower outside the physician's office, probably because of the patient's increased awareness and decreased anxiety in other settings. When blood pressures are normal at home, the patient may be able to avoid antihypertensive therapy, antepartum hospitalization, and intervention during her pregnancy. Monitoring at home or work also provides a more thorough screening for preeclampsia, especially with patients who have chronic hypertension or other predisposing conditions.

Ambulatory Care↗
PubMed1992

Fetal drug therapy: an overview of selected conditions.

Fetal drug therapy may be defined as the administration of any drug for the primary or sole purpose of treating a fetal disorder or in the hope of improving the capacity for later intrauterine or postnatal adaptation. In several intrauterine conditions, the drug exposure has been directed at the fetus rather than the mother. Progress in clinical investigation has been slowed by often unfounded fears of malformations and potential litigation. Since 1975, federal regulations have required that the fetus be protected and subjected to no more than minimal additional risk. Although no large-scale trials have been reported, drug administration has been proven to aid the fetus in many circumstances. Such treatment has been administered primarily during the second or third trimester and is generally short-term, preventive, and without apparent risk to the consenting mother. The published reports have made obstetricians aware of both the limits of our knowledge in this area and new applications for innovative fetal monitoring by the latest technology. Whether such therapy has a role in the care of the unborn infant will depend on accumulation of a larger body of information and the continued cooperation of basic scientists and clinical investigators.

Clinical Trials as Topic↗
PubMed1991

Uterine and fetal Doppler flow changes after intravaginal prostaglandin E2 therapy for cervical ripening.

Nineteen patients received prostaglandin E2 as a 2.5 mg gel (seven cases), 3.3 mg chip (five cases), or 10 mg controlled-release pessary (seven cases) for preinduction cervical ripening. Blood flow velocities did not change significantly for the uterine arcuate artery, fetal aorta, and umbilical artery circulations after any of the treatments. In no case did systolic/diastolic ratios consistently elevate above baseline values.

Blood Circulation↗
PubMed1991

Patterns of uterine activity after intravaginal prostaglandin E2 during preinduction cervical ripening.

In a randomized study, uterine activity patterns were characterized with a portable pressure-sensitive device in 40 nonlaboring women at term with an unfavorable cervix who were undergoing preinduction cervical ripening with prostaglandin E2. The prostaglandin E2 was inserted into the posterior vaginal fornix as a single dose of either a 2.5 mg methylcellulose gel (20 cases) or 10 mg controlled-release pessary (20 cases). Uterine activity monitoring began 1 hour before dosing and continued for 12 hours. For those treated with the gel, low-amplitude, high-frequency contractions began within the first hour, reached a peak within 4 hours, and initiated sustained high-amplitude contractions in 10 (50%) cases. With the controlled-release pessary, low-amplitude, high-frequency contractions had a slightly later onset, reached a peak between the fifth and eighth hours, and initiated sustained high-amplitude contractions in 18 (80%) cases. Uterine hyperstimulation occurred in two (10%) pessary cases, with no adverse effect after removal. We conclude that low-amplitude, high-frequency uterine contractions began with either method of intravaginal prostaglandin E2 delivery but led to sustained, high-amplitude contractions primarily with the pessary.

Administration, Intravaginal↗
PubMed1991

Blood pressure self-monitoring during pregnancy: practical considerations.

Portable electronic and mechanical aneroid instruments for blood pressure self-monitoring are available, inexpensive, and reasonably accurate. Instructing the patient at risk for borderline, mild hypertension or chronic hypertension during pregnancy on self-monitoring of blood pressure has advantages. Combined with conventional office measurements, many daily recordings give an accurate picture of an individual's dynamic blood pressure. Lower blood pressures commonly found outside the office are likely attributable to an increased awareness, less anxiety, and attention by the patient to nonpharmacologic factors. Such persons may well avoid antihypertensive therapy or antepartum hospitalization. This information provides a strong incentive to undertake and adhere to an appropriate plan of treatment for those patients whose hypertension is confirmed by blood pressure self-monitoring technique. We consider blood pressure self-measurement to complement other reported monitoring techniques for active patient participation at home or in the work setting. It also permits an early evaluation of blood pressure alterations to rule out preeclampsia, especially in the pregnant patient with chronic essential hypertension.

Blood Pressure Determination↗
PubMed1991

Failed induction of labor despite sequential prostaglandin E2 therapy.

Preinduction cervical ripening with prostaglandin E2 (PGE2) is useful in minimizing the chances for a failed induction of labor. The lack of sufficient cervical dilation despite PGE2 and oxytocin therapy is uncommon. This investigation was undertaken to determine reasons for any failed inductions in pregnancies with pregel Bishop scores 4 or lower and requiring delivery within 24 hours. Fifteen (12.1%) of 124 eligible patients had failed inductions despite two 2.5 mg intravaginal doses. A finding in all the failures was a very unfavorable cervix (pregel Bishop score 0 to 2). The need for preterm delivery (33 to 37 weeks) was a common finding in the presence of a very unfavorable cervix. The data suggest that complicated pregnancies requiring delivery within 24 hours and failing to respond to sequential PGE2 therapy in the presence of a very unfavorable cervix may benefit from cesarean section without a prolonged induction.

Administration, Intravaginal↗
PubMed1991

Fetal habituation to vibroacoustic stimulation in uncomplicated term pregnancies.

The use of transabdominal vibroacoustic stimulation has been shown to improve the efficiency of antepartum fetal surveillance. The ability of the fetus to habituate to such a stimulus has also been suggested as a means of assessing the function of the central nervous system. The purpose of this blinded prospective investigation was to evaluate fetal habituation in a group of low-risk pregnancies anticipated to deliver within 1 week. One hundred sixteen uncomplicated pregnancies underwent repetitive vibroacoustic stimulation using a Corometrics Model 146 fetal acoustic stimulator. Fetal habituation was defined as a sustained elevation of the heart rate baseline for more than 15 minutes or a failure to produce an adequate acceleration of the fetal heart rate after an initial response. Habituation was present in 106 (91.4%) cases, whereas 10 (8.6%) failed to habituate to the stimulus. All infants failing to habituate in utero ultimately did well after delivery. Their birthweights, Apgar scores, umbilical artery blood gas determinations, and courses in the newborn nursery were similar to those of infants who responded to in utero sound stimulation. However, cesarean delivery for fetal distress and gross placental abnormalities (such as infarction and abruption) occurred more commonly in those fetuses failing to habituate. Additional investigations of fetal habituation to a vibroacoustic stimulus may be helpful in the intrapartum risk assessment of uncomplicated term pregnancies.

Acoustic Stimulation↗
PubMed1991

Pharmacologic therapy for fetal arrhythmias.

Although great strides have been made in diagnosing fetal cardiac anatomic and functional abnormalities, in utero cardiac therapy is limited to the treatment of significant arrhythmias. The fetal prognosis may change if the dysrhythmia persists or if the condition results in intrauterine heart failure. When either complication is evident, intrauterine drug therapy may be indicated if the fetus is considered too immature for delivery. Information from case reports has shown several drugs to be useful to cardiovert the fetus, with digitalis being the pharmacologic agent used most often. At present, treatment consists mainly of transplacental administration of antiarrhythmic agents with the object of normalizing FHR and rhythm and abolishing, or preventing, fetal cardiac failure. Various agents have been used with variable success. More direct fetal therapy by intramuscular injection or umbilical vein infusion may replace unsuccessful indirect maternal therapy. It is unclear why some fetuses respond (or appear to respond) and others have hydrops and die in the absence of congenital heart disease or documented infection. With proper therapy, many fetuses survive and have a satisfactory prognosis, depending on the form of arrhythmia and the nature of any cardiac structural defects.

Arrhythmias, Cardiac↗
PubMed1991

Research involving fetal drug therapy: ethical, legal, and practical considerations.

Fetal drug therapies have emerged as a promising avenue for the prevention or correction of disease during fetal or immediate postnatal life. Despite slow progress, several medications have been developed for in utero therapy of disorders which relate to fetal and neonatal pulmonary, cardiac, neurologic, and growth disorders. However, ethical and regulatory constraints require protection of the mother and fetus while causing no more than necessary additional risk. Appreciating these constraints will lead to the identification of pragmatic questions which should be answered before evaluating the efficacy and safety of a particular treatment or research proposal.

Aborted Fetus↗
PubMed1991

Nalbuphine after major gynecologic surgery. Comparison of patient-controlled analgesia and intramuscular injections.

A randomized investigation compared the efficacy and safety of nalbuphine administered by two methods, a patient-controlled infuser system and intramuscular (IM) injections, after major gynecologic surgery. Forty-seven patients were randomly assigned to receive nalbuphine by either method. The 22 patients using the infuser were given a 2.0-mg, incremental dose with a 10-minute lock-out interval between doses. A similar group receiving 10-15 mg IM every three hours served as the control. Misprogramming, overdosage, depressed respiration and drug dependence were not encountered. Self-administration provided equally satisfactory sedation and more immediate pain relief without painful injections. Although patients with the infuser had the ability to self-administer more medication, they did not use higher doses of nalbuphine than did the IM group. The additional cost of the infuser system was offset by the satisfaction expressed by the patients and by the improved nursing efficiency. Nalbuphine administered with a patient-controlled infuser provided an effective balance between analgesia and sedation and offered advantages over IM injections.

Adult↗
PubMed1991

Comparison of patient-controlled analgesia and epidural morphine for postcesarean pain and recovery.

A greater awareness of the advantages and limitations of new methods of administering postcesarean analgesia would help the obstetrician care for the recovering patient. Patient-controlled analgesia and epidural morphine are two new modalities for postoperative pain relief. The purpose of this prospective investigation was to compare their effectiveness, safety, side effects, patient satisfaction and cost. During an eight-month period, 161 women undergoing cesarean delivery were assigned to receive narcotics by either epidural morphine (76 patients) or patient-controlled analgesia (85 patients) using a combined continuous infusion and demand dosing of meperidine. The demographic characteristics of the two groups were similar. Mild or no pain was reported with similar frequencies in both groups. No reduced respiration or undesired sedation was seen in either group. The postoperative times before sitting at the bedside, ambulating, tolerating clear liquids and leaving the hospital were also comparable. No complications were encountered with patient-controlled analgesia, but pruritus and alarms from apnea monitors occurred commonly in the epidural morphine group. The costs to the patient were similar for the two groups. Patient-controlled analgesia using a combined continuous infusion and demand dosing is an acceptable alternative to epidural morphine after cesarean delivery.

Adult↗
PubMed1991

The escalating cesarean section rate: a 25 year experience at the University of Nebraska Medical Center.

The cesarean section rate at our medical center has increased gradually from 9.1% in 1965 to 21.9% in 1989, which is lower but similar to national trends. This upward trend was reversed in 1990 by more strongly encouraging vaginal births after cesarean section, attempting more vaginal deliveries in select cases of breech presentations, and complying with national guidelines for defining fetal distress and dystocia. Recommendations are offered for the development of statewide guidelines for peer review and quality assurance.

Cesarean Section↗
PubMed1991

Patient-controlled analgesia in obstetrics and gynecology.

Patient-controlled analgesia, which provides pain relief through self-administration of intravenous doses of opioids, is widely available and advocated as an effective analgesic modality. This report reviews published experiences with patient-controlled analgesia during labor and after cesarean delivery or major gynecologic surgery. Currently employed devices allow accurate record-keeping of drug use and permit patient mobility. No one device has been shown to be preferable. The form of administration most commonly described is infusion of morphine or meperidine on demand without combined continuous basal infusion. During labor, brief but progressively intensifying episodes of pain undermine the effectiveness of these devices when used intravenously. Compared with intramuscular administration of narcotics, patient-controlled analgesia after cesarean or major gynecologic surgery has been judged by patients to be more acceptable in achieving a balance between tolerable pain and sedation. Respiratory depression has been rare and is often attributable to misprogramming. Costs of these devices can be justified with frequent usage and are at least partially offset by more efficient use of nursing personnel for pain management.

Analgesia↗
PubMed1990

Uterine hyperstimulation after low-dose prostaglandin E2 therapy: tocolytic treatment in 181 cases.

There is limited information about uterine hyperstimulation after low-dose prostaglandin E2 therapy. The purpose of this retrospective study was to describe our combined experience with this undesired effect by use of three techniques for prostaglandin E2 administration. Uterine hyperstimulation was present if the contraction frequency was more than five in 10 minutes or if contractions exceeded 2 minutes in duration. A total of 181 cases were evaluated during a 51-month period. The rates of hyperstimulation were 7.3% (167/2297) in the group that received intravaginal tablets (3.0 mg), 2.9% (12/408) with intravaginal gel (2.5 mg), and 0.5% (2/394) with intracervical gel (0.5 mg). Hyperstimulation usually began within the first hour for the group that used gel and within the first 4 hours for the tablet group. A beta 2-adrenergic drug (hexoprenaline or terbutaline) was infused routinely without adverse effects and with rapid resolution of the worrisome findings in 178 (98.3%) cases. The remaining three cases required cesarean delivery and had no evidence of neonatal compromise. We conclude from this large, combined series that uterine hyperstimulation after low-dose prostaglandin E2 therapy is uncommon and usually rapidly reversible with beta 2-adrenergic therapy without apparent untoward effects.

Administration, Intravaginal↗
PubMed1990

Double-blind comparison of intravaginal prostaglandin E2 gel and "chip" for preinduction cervical ripening.

The intravaginal application of prostaglandin E2 for preinduction cervical ripening has proved to be advantageous in the management of patients with an unfavorable cervix. The purpose of this double-blind randomized investigation was to compare the efficacy and safety of two methods of prostaglandin E2 delivery. Patients who were to have preinduction cervical ripening because of an unfavorable cervix (Bishop score less than or equal to 4) were randomly assigned to be given a single dose of prostaglandin E2 as either 2.5 mg of gel or a 3.0 mg "chip" intravaginally in a placebo-controlled manner. Sixty-nine patients received the active prostaglandin E2, 34 in the gel group and 35 in the "chip" group. The groups were similar in maternal age, race, parity, gestational age, and initial Bishop score. Both forms of prostaglandin E2 were easy to administer and helpful in priming an unfavorable cervix. The need for, duration of, and maximum dose of oxytocin were similar in both groups. Cesarean delivery because of failed induction occurred in 5 of 35 (14.3%) patients receiving a "chip" and 4 of 34 (11.8%) receiving the gel. However, patients receiving a "chip" experienced a 20% (7/35) incidence of hyperstimulation, compared with 2.9% (1/36) in those receiving the gel (p less than 0.05). The only case requiring immediate cesarean delivery because of intractable uterine hyperstimulation received a "chip." We conclude that both methods were effective for cervical ripening, but the lower incidence of uterine hyperstimulation seen with the gel would suggest that it is preferable to the "chip."

Administration, Intravaginal↗
PubMed1990

Effect of a single dose of oral pseudoephedrine on uterine and fetal Doppler blood flow.

Pseudoephedrine, a stereoisomer of ephedrine with alpha- and beta-adrenergic properties, is the active ingredient in over-the-counter oral decongestants. Its safety during pregnancy has not been studied adequately. The purpose of this investigation was to evaluate the effects of pseudoephedrine on uterine and fetal Doppler blood flows. Twelve healthy pregnant women between 26-40 weeks' gestation ingested a standard 60-mg dose of pseudoephedrine. A pulsed Doppler system was used to perform blood flow measurements of the uterine arcuate artery, fetal aorta, and umbilical artery before dosing, immediately thereafter, and at 15-minute intervals during the first 3 hours after drug ingestion. Blood flow velocities were not altered significantly after dosing in either the maternal or fetal circulation. In no case did absolute fetal or uterine blood flow velocities decrease significantly or systolic/diastolic ratios persistently elevate to abnormal values. We conclude that no significant alterations in the uterine or fetal circulations occur after the ingestion of a single dose of oral pseudoephedrine by healthy pregnant patients in the third trimester.

Administration, Oral↗