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Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 109 records · Page 6Linked to original sources
PubMed1990

Parenteral nutrition in obstetric patients.

PN is required to maintain or restore an anabolic state when oral enteral routes are not feasible. Despite 22 years of experience with PN, its use during pregnancy has only recently been reported. Most of this information is anecdotal but suggests that this mode of therapy is safe, effective, and occasionally lifesaving. PN during pregnancy has been used most often to provide adequate nutrition for those who suffer from prolonged hyperemesis or who have difficulty absorbing adequate nutrients because of such conditions as Crohn's disease. The proper selection and administration of dextrose, fat, protein, vitamins, trace elements, and electrolytes for pregnant women have been associated with favorable perinatal outcomes. Fat emulsion use does not appear to be associated with any abnormal outcomes. Preterm deliveries and intrauterine fetal growth retardation appear to relate to preexisting or coexisting medical or obstetric complications. Principles for PN with all patients would apply during pregnancy. As with any therapy, the benefits must be weighed against the risks and costs. Sufficient favorable clinical experience over the last 10 years suggests that PN is a relatively safe and effective method for reversing maternal malnutrition and promoting normal fetal growth and development.

Clinical Trials as Topic↗
PubMed1990

Fetal body movement monitoring.

Recording fetal activity serves as an indirect measure of central nervous system integrity and function. The coordination of whole body movement, which requires complex neurologic control, is likely similar to that of the newborn infant. Short-term observations of the fetus are best performed using real-time ultrasound imaging. Monitoring fetal motion has been shown to be clinically worthwhile in predicting impending death or compromise, especially when placental insufficiency is longstanding. The presence of a vigorous fetus is reassuring. Perceived inactivity requires a reassessment of any underlying antepartum complication and a more precise evaluation by fetal heart rate testing or real-time ultrasonography before delivery is contemplated.

Female↗
PubMed1990

Uterine and fetal Doppler flow changes from a single dose of a long-acting intranasal decongestant.

Oxymetazoline, an alpha-adrenergic agent, is the active vasoconstrictor in long-acting intranasal decongestants. This investigation studied the effects of oxymetazoline on the maternal and fetal circulations. Twelve healthy gravid patients in the third trimester (27-39 weeks) underwent flow velocity measurements by the same sonographer using a pulsed Doppler system (ATL Ultramark 4 machine). Maternal and fetal indices were recorded 15 minutes before dosing, immediately thereafter, and at 15-minute intervals during the first 2 hours after the drug was given. No significant changes were found in either the maternal blood pressures or pulse rates. Blood flow velocities did not change significantly from baseline for the uterine arcuate artery, fetal aorta, or umbilical artery circulations. In no case did absolute blood flow velocity decrease significantly or systolic/diastolic ratios elevate to worrisome values. For uncomplicated pregnancies, we conclude there are no significant acute changes in the maternal and fetal circulations after a single dose of intranasal oxymetazoline.

Administration, Intranasal↗
PubMed1990

Perinatal outcomes of twin pregnancies at term.

A review of a two-year experience in our community disclosed that 57% of twin pregnancies (118/207) deliver at term. Little attention has been focused on perinatal outcomes of twin pregnancies remaining undelivered after 36 completed weeks. Therefore, we reviewed our experience to determine whether our practice should change to maximize perinatal care. Nearly all the study pregnancies (115/117, or 97.5%) delivered by the estimated date of confinement. Fetal malpresentation, failure to progress and the patient's lack of desire for a vaginal birth after cesarean delivery were common reasons for the high cesarean rate (62/117, or 52%). The neonatal outcomes were favorable regardless of the route or interval between deliveries. Discordant fetal growth was found in only eight cases (6.8%). No perinatal deaths occurred, and five-minute Apgar scores less than 7 (2/234, or 0.9%) and rates of anomalies (5/234, or 2.1%) were not different from those in singleton pregnancies delivering during the same period. Using the principles of obstetric practice used in our community, we would expect the perinatal outcomes in term twin gestations to be favorable.

Cesarean Section↗
PubMed1990

Perinatal outcome after a prolonged second stage of labor.

It is commonly held that the second stage of labor should last no more than two hours because of an apparently increased risk of morbidity. The purpose of this investigation was to determine whether this commonly held notion is true in this era of close fetal monitoring and umbilical blood gas determination. Between May 1987 and October 1988, 50 (3.5%) of 1,432 uncomplicated term pregnancies ended in delivery after a second stage of labor lasting greater than 120 minutes. A prolonged second stage was associated more commonly with nulliparity, occiput posterior positioning, epidural anesthesia and a need for operative delivery but not birth weight greater than 4,000 g or a short umbilical cord. Infants born after a prolonged second stage did not have an increased incidence of umbilical artery pH less than 7.20 or of five-minute Apgar scores less than 7, nor did they need intensive care nursery admission. A prolonged second stage of labor appears not to impose an increased hazard on the fetus but does require close fetal monitoring and increases the possibility of operative delivery.

Apgar Score↗
PubMed1990

Reliability of compact electronic blood pressure monitors for hypertensive pregnant women.

Self-monitoring of blood pressure is an asset to managing hypertensive pregnant women on an outpatient basis. Many brands of electronic blood pressure devices are now available for use during pregnancy. An investigation was undertaken to compare the relative accuracy and acceptability of four of the least expensive and most compact units (Sunbeam III, Norelco, Lumiscope and Marshall). The reliability of the devices was compared with simultaneous measurements using a Dinamap 845A monitor on 22 pregnant hypertensive women. All measurements were performed without difficulty by a skilled observer and the patients. The accuracy varied, but each electronic device was considered as accurate as a mechanical aneroid unit available at the same retail stores. The advantages of these electronic units were ease of application and readability of the measurements without the need for a stethoscope or an assistant.

Adult↗
PubMed1989

Prostaglandin E2 gel for cervical ripening and induction of labor: a critical analysis.

This report summarizes the cumulative experience of 3313 pregnancies represented in 59 prospective clinical trials in which intracervical or intravaginal prostaglandin E2 gel was used for cervical ripening before induction of labor. Results indicate that local prostaglandin E2 is superior to placebo or no therapy in enhancing cervical effacement and dilation, reducing initial induction failures, shortening the induction-delivery interval, reducing oxytocin use, and lowering the rate of cesarean section because of failure to progress. Certain advantages also exist for labor induction in the presence of a favorable cervical state. Uterine hyperstimulation or pathologic fetal heart rate patterns before oxytocin administration occur in less than 1% of reported cases and are usually dose related, self contained, and reversible with the use of beta-adrenergic tocolytic therapy. Maternal systemic effects in these low doses are negligible. Worldwide clinical experience has clearly demonstrated that prostaglandin E2 gel administered before induction of labor is of major therapeutic benefit and should become commercially available for more than investigational use.

Cervix Uteri↗
PubMed1989

Dystocia in late labor: determining fetal position by clinical and ultrasonic techniques.

A failure of adequate progression during late labor occurs often and may prohibit an accurate determination of the fetal head position from scalp edema or caput formation. This investigation was undertaken to determine whether ultrasonic evaluation could confirm or correct the digital examination impressions of the fetal head position. Eighty-six attempted vaginal deliveries had recent evidence for arrested cervical dilation after 7 cm or more. An occiput transverse position in 24 (28%) cases was diagnosed accurately, with the need for additional ultrasonic information only in the presence of scalp edema. Distinguishing between a persistent occiput posterior (15 cases, 17%) or anterior (47 cases, 55%) position was often inexact by palpation alone. Combined clinical and ultrasonic impressions allowed for a significantly more precise diagnosis. Ultrasonic imaging allowed for more security while waiting, more confidence with midforceps application, or a prompter decision for cesarean section, depending on the head position.

Adult↗
PubMed1989

Postpartum pain after vaginal delivery. A review of comparative analgesic trials.

Perineal tissue injury and uterine cramping within the first 24-48 hours after vaginal delivery are established models for studying pain relief. In this study, information was gathered from prospective, randomized investigations comparing the safety and efficacy of several oral analgesics. Nonsteroidal antiinflammatory drugs (NSAIDs) have been found consistently to be more useful than a placebo or acetaminophen. As compared with aspirin, the newer NSAIDs had a more delayed onset of action but required fewer doses. Mild analgesics were usually all that was necessary, and a combination with codeine was usually unnecessary. Side effects and breast milk concentrations of the drugs were negligible for this short-term therapy. Although no drug was found to be preferable to the others, aspirin and ibuprofen were the least expensive.

Analgesics↗
PubMed1989

Randomized comparison of meperidine and fentanyl during labor.

This randomized investigation compared the efficacy of the conventional narcotic, meperidine, and a more potent and short-acting analgesic, fentanyl, during labor. One hundred five women with uncomplicated term pregnancies in active labor were randomly assigned to receive either intravenous fentanyl (50-100 micrograms every hour) or meperidine (25-50 mg every 2-3 hours) in a non-blinded manner. The analgesics were rated equivalent in efficacy. Maternal nausea, vomiting, and prolonged sedation occurred more frequently in the meperidine group. Naloxone use was significantly less in fentanyl- than in meperidine-exposed infants (one of 49 versus seven of 56; P less than .05). Neuroadaptive testing at approximately 2 hours and 24 hours postnatally revealed similar averaged scores in the two groups. Using the described intravenous dosing schedule, fentanyl was preferable to meperidine during labor because there was no prolonged maternal sedation or vomiting necessitating therapy and the requirement for neonatal naloxone was reduced.

Analgesia↗
PubMed1988

Intraventricular hemorrhage in preterm twin gestation infants.

The incidence of intraventricular hemorrhage (IVH) in twin pregnancy infants with birthweights less than 1500 g in a 5 year period was examined retrospectively. Of the 70 infants in this birthweight category (for which IVH status was known) born at the University of Michigan Medical Center between January 1980 and December 1984, 20 had IVH (29%) (p = NS). The only significant association with IVH was respiratory distress. Presentation, route of delivery, a low 5 minute Apgar score, and time between first and second delivery were not significant factors. However, a multiple logistic regression of the infants categorized by IVH status demonstrated significant effects of twinship itself and of birth order within a given twinship. The unexpected low incidence of IVH in this high risk group suggests that better obstetric and neonatal management of low birthweight preterm twins at tertiary care centers may result in improved survival and decreased morbidity including intraventricular hemorrhage.

Birth Order↗
PubMed1988

Patient-controlled analgesia for post-cesarean section pain.

Recent reports have suggested that patient-controlled analgesia is an effective means of narcotic administration in postoperative patients. This prospective investigation was undertaken to determine the efficacy and safety of patient-controlled anesthesia infusion after cesarean section. During a recent ten-month period, 130 patients were assigned randomly to receive meperidine by pump or intramuscular injection. Meperidine consumption using the device varied widely to meet individual needs. Overdosage and drug dependence were not encountered with the prescribed drug concentrations. The patient-controlled analgesia method provided less sedation and more immediate pain relief without the need for painful injections. The additional cost of renting the infuser device was offset by combined patient and nursing satisfaction. We conclude that patient-controlled infusion of meperidine is safe and effective in satisfying individual patient needs after cesarean section.

Analgesia↗
PubMed1988

Third- and fourth-degree perineal tears. 50 year's experience at a university hospital.

An investigation was undertaken to determine if the incidence of third- and fourth-degree perineal tears has changed and, if so, what the predisposing factors might be. Data were analyzed for a 50-year period (1935-1985). An increased frequency of such tears was found after 1965, when mediolateral episiotomies were replaced almost entirely by midline ones. A constant combined rate of 17% for third- and fourth-degree tears was found for the last decade. When compared with a similar group without such tears, women with extensive tears were more likely to be nulliparous and teenage and to require epidural anesthesia, oxytocin and/or forceps application. When the incidence of tears was compared with that at a nearby community hospital, it was found to be higher at our university medical center. Excluding physician inexperience, the reason was the greater frequency of teenage pregnancies and more common use of epidural anesthesia and oxytocin at our hospital. Rectovaginal fistulae and anal incontinence requiring repair occurred in less than 1% of the total cases. Since midline episiotomies are now being performed often, third- and fourth-degree perineal tears will continue to be common and will depend on the patient population, physician experience and intrapartum hospital policies.

Anesthesia, Epidural↗
PubMed1987

Gestational diabetes screening in a private, midwestern American population.

This prospective investigation was undertaken to compare the value of routine versus selective diabetes screening in a group of predominantly middle-class, healthy, Caucasian pregnant women. Two thousand consecutively chosen persons were divided into two groups: those to undergo routine screening between 24 and 28 weeks' gestation and those to be tested selectively in the presence of standard risk factors. The two groups of patients were otherwise similar. The method of screening involved a 50 gm oral glucose challenge, followed by a 3-hour glucose test if necessary. The incidence of gestational onset diabetes in the selectively screened group (19/453, 4.2%) was twice that in the routinely screened group (21/1000, 2.1%). Evidence of glucose intolerance without a risk factor was found in only one case (1/1000, 0.1%) in the routinely screened group. This assessment of our clinical practice has allowed us to safely eliminate the need for diabetes screening in more than half of our private patients, which will reduce office time, patient inconvenience, and expense.

Female↗
PubMed1987

Intrapartum fetal heart rate patterns and neonatal intraventricular hemorrhage.

A goal for the obstetrician and neonatologist is to screen for risk factors associated with intraventricular hemorrhage (IVH) in the low-birthweight infant. Perinatal events that lead to neonatal metabolic and cardiovascular derangements seem to provoke IVH, and conflicting reports have implicated labor as being contributory. A fetal heart rate (FHR) abnormality during premature labor may be a predictor of subsequent neonatal IVH. For this reason, 5 years of FHR tracings at two university medical centers were reviewed for inborn infants who were delivered after premature labor and weighed less than or equal to 2000 gm. Sixty-four infants developed IVH, but pre-existing labor with a discernible FHR pattern was recorded in only 38 (59%) cases. Interpretations were reassuring in 17 (45%) cases, suspicious in 7 (18%) cases, and ominous in 14 (37%) cases. This proportion of FHR patterns was not significantly different from a matched group of premature infants without IVH during the same period. Interpretations of intrapartum FHR patterns of low-birthweight infants are limited, especially before 30 weeks gestation, and not useful in predicting neonatal IVH.

Adult↗
PubMed1987

Monitoring fetal body movement.

Early in gestation the fetus is active, with movements reflecting several different central nervous system functions. Specific muscle actions of the limbs and trunk respond to different brain stimuli. Sporadic head, trunk, and limb motions that are spastic in quality eventually give way to more combined, sustained, and regular motions as integration develops. This progressive complexity in stimulus reaction has been evaluated with continuous observation using real-time ultrasound imaging. Monitoring gross fetal body motion has gained acceptance as being useful in predicting impending fetal compromise and even death, especially in the presence of chronic placental insufficiency. Prolonged or frequent body movements noted by maternal perception, electromechanical monitoring, and ultrasound imaging are reassuring findings. Fetal inactivity should be documented and requires a reassessment of any underlying antepartum complication and a more precise evaluation of fetal well-being with the use of other techniques. An adequate interpretation and an explanation of these findings to the pregnant woman is necessary to prevent undue stress from misinformation.

Female↗
PubMed1987

Immunoglobulin therapy for autoimmune thrombocytopenia purpura during pregnancy. A report of two cases.

High-dose, intravenous immunoglobulin therapy may be effective in elevating low platelet counts in nonpregnant patients with autoimmune thrombocytopenia purpura (ATP). We used immunoglobulin successfully on two pregnant women with ATP who had been refractory to high-dose corticosteroid therapy. The 5-day infusions were started at 12 and 29 weeks' gestation, and the subsequent uncomplicated vaginal deliveries occurred after the shortest reported interval (8 days) and longest (28 weeks) following a single immunoglobulin infusion. A splenectomy was avoided, and no adverse maternal or neonatal effects were apparent.

Adult↗