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Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 145 records · Page 8Linked to original sources
PubMed1982

Clinical implications from monitoring fetal activity.

The monitoring of fetal motion in high-risk pregnancies has been shown to be worthwhile in predicting fetal distress and impending fetal death. The maternal recording of perceived fetal activity is an inexpensive surveillance technique which is most useful when there is chronic uteroplacental insufficiency or when a stillbirth may be expected. The presence of an active, vigorous fetus is reassuring, but documented fetal inactivity required a reassessment of the underlying antepartum complication and further fetal evaluation with real-time ultrasonography, fetal heart rate testing, and biochemical testing. Fetal distress from such acute changes as abruptio placentae or umbilical cord compression may not be predicted by monitoring fetal motion. Although not used for routine clinical investigation, electromechanical devices such as tocodynamometry have provided much insight into fetal behavioral patterns at many stages of pregnancy and in pregnancies with an antepartum complication.

Circadian Rhythm↗
PubMed1982

Activity patterns in malformed fetuses.

Knowledge of a malformed fetus before the onset of labor would assist the physician in preparing the expectant parents, managing the timing and method of delivery, and preparing for the immediate care of a salvageable infant. This 3-year prospective investigation compared the activity patterns of fetuses who were later found to have major malformation with those of fetuses who had no apparent defects. Fetal motion over prolonged periods was determined by daily charting of fetal movement by the mother. Although not a reliable predictor for all malformations, evidence of fetal inactivity was found to be more common (p less than 0.0001) among fetuses with anomalies (16 of 58 cases, 28%) than among those with no defects (39 of 1,098 cases, 4%). All malformations associated with fetal inactivity were strongly suspected ultrasonographically and included hydrocephalus, gastroschisis, nonimmune hydrops, bilateral renal agenesis, and bilateral dislocation of the hips. Documentation of fetal inactivity is helpful in recognizing certain major malformations and constitutes grounds for more detailed study by ultrasonography.

Ascites↗
PubMed1982

Fetal activity patterns in hypertensive pregnancies.

This prospective investigation attempts to determine whether the maternal recording of perceived fetal motion is useful for fetal assessment in pregnancies complicated by hypertension. During a 21 month period, 124 patients whose pregnancies were complicated by either chronic or pregnancy-induced hypertension participated. The number of perceived movements per hour (24 +/- 11, mean +/- S.D.) and evidence for fetal inactivity (7 cases, 6%) did not vary significantly from a control group of normotensive pregnancies (p greater than 0.05). Fetal inactivity was predictive of an unfavorable perinatal outcome in 6 of 7 cases, including the three stillborn infants. No perinatal deaths occurred among the 117 hypertensive pregnancies with active fetuses, and the 6 cases with an unfavorable outcome were associated with mild intrauterine growth delay, prematurity, or acute changes such as placental abruption or umbilical cord accidents. Realizing these limitations, a record of fetal inactivity is worthwhile in managing the pregnancy complicated by hypertension.

Adult↗
PubMed1982

Conditions affecting nonstress test results.

A prospective investigation was conducted to examine associations between selected conditions encountered during nonstress testing with the intent of explaining false nonreactive results. During a 16-month period, nonstress tests (NSTs) were performed in 315 pregnancies; 64 (12%) of the initial 534 satisfactory tests had nonreactive patterns. Approximately one third (22 of 64, 34%) of these nonreactive tests either remained nonreactive or were followed by a positive or suspicious contraction stress test that same day. When compared with pregnancies that gave reactive test results, a nonreactive pattern was not found to be more commonly associated with maternal obesity, fasting, certain prescribed medications (methyldopa, phenobarbital, insulin), time of day, or recent amniocentesis. Recent cigarette smoking was infrequent (108 tests, 20%) but might explain a falsely nonreactive result. The data suggests that NST results might instead have been influenced by fetal activity and fetal health during the test period.

Adolescent↗
PubMed1982

Antepartum prediction of the postmature infant.

A prospective investigation was undertaken to determine whether present antepartum methods of fetal assessment were useful in predicting postmaturity. Thirty-two (22%) of 147 strictly defined postdate pregnancies produced infants with signs of postmaturity. Clinical findings, fetal heart rate testing (primarily nonstress tests), and fetal movement charting were not found to be reliable predictors. Single-voiding estrogen:creatinine (E:C) ratios were significantly (P less than .0001) lower in fetuses with subsequent findings of postmaturity than in those without such signs, and all subnormal values were associated with postmature infants. Twenty-four of 29 pregnancies with oligohydramnios diagnosed by ultrasonography produced postmature infants, whereas 110 of 118 pregnancies with either pockets or an adequate volume of amniotic fluid produced infants who were not postmature. Of the fetal surveillance methods used in the authors' clinic, subnormal E:C ratios and ultrasonic evidence of oligohydramnios were the most reliable predictors of postmaturity.

Adult↗
PubMed1981

Mitral valve prolapse and pregnancy.

Mitral valve prolapse (MVP) is the most common congenital heart lesion, and the diagnosis is frequently made in young women of childbearing age. The management of this disorder during pregnancy has not been well studied. Our investigation reviews the outcomes of 42 pregnancies among 25 patients with MVP diagnosed before conception by the characteristic auscultatory and echocardiographic findings. All patients with no other cardiovascular disorder tolerated pregnancy well and developed no remarkable cardiac complications. Furthermore, the incidence of antepartum and intrapartum complications or signs of fetal distress was not greater when compared with pregnant patients with no known cardiac disorder (p greater than 0.05). Congestive heart failure occurred in one case in which premature labor with coexisting toxemia was treated with the combined intravenous administration of a beta adrenergic tocolytic drug, a glucocorticoid drug, and a large volume of fluids.

Adult↗
PubMed1981

Predictability of the distressed term infant.

The delivery of a distressed term infant is infrequent but often requires intensive therapy. This study investigates the primary causes for such distress and the period (antepartum intrapartum, neonatal) when each complication was initially recognized. During a 1-year period, 168 term infants (8% of 2,057 term deliveries) required admission to the newborn intensive care unit. The primary disorders were similar to those of 228 infants transported from community hospitals and involved suspected sepsis, metabolic problems, major anomalies, birth asphyxia, and respiratory distress. Only one third (59 cases, 35%) of the subsequently distressed infants was anticipated during the antepartum period. The term infant who requires more than routine nursery care cannot necessarily be predicted until labor or delivery.

Female↗
PubMed1981

Management of the uncomplicated postdate pregnancy.

The management of a postdate (greater than 42 weeks) pregnancy with no apparent complication is often unclear. This study compares the intrapartum courses and perinatal outcomes between 101 postdate pregnancies and 322 term pregnancies. The mean maternal age, race, parity and type of care service were not significantly different between the two groups. Signs of fetal compromise were also not different, but a large fetus was more common (p less than 0.01) in the postdate pregnancies (16 cases). The need for cesarean section (13 cases) or midforceps manipulation (7 cases) was increased fourfold in the postdate over the term pregnancies (p less than 0.05). Meconium during labor was not more common in the postdate pregnancies, but the one postdate perinatal death occurred in the neonatal period from severe meconium aspiration complications. A postdate pregnancy with no apparent complications may safely be observed closely.

Adult↗
PubMed1981

Umbilical cord length and intrapartum complications.

The length of umbilical cords was studied in 536 term deliveries to test the hypothesis that a short or long umbilical cord is more frequently associated with certain intrapartum complications. The mean umbilical cord length was 55 cm (range, 14 to 129 cm). A short cord was defined as 35 cm or less (lower sixth percentile). Umbilical cord accidents were most frequent in the presence of a long cord (20 of 32 cases, 62%). Inadequate fetal descent was significantly more common when a long cord or an excessively short cord (25 cm or less, lower first percentile) was found. Fetal heart rate (FHR) abnormalities that primarily reflected cord compression patterns were significantly more frequent in the presence of a short (17 of 27 cases, 63%) or a long cord (28 of 32 cases, 87%), as compared with a normal length cord (145 of 393 cases, 37%). The measurement of umbilical cord length requires minimal effort, no expense, and may explain certain intrapartum FHR abnormalities or an arrest of fetal descent.

Female↗
PubMed1981

Effect of serum lipids on radioimmunoassays of unconjugated estriol in serum.

Controversy regarding the presence of a circadian rhythm in unconjugated estriol in serum during pregnancy led us to study the possibility that the observed rhythms actually are the result of partitioning of estriol into serum lipids when these increase postprandially. Addition of triglycerides to purified estriol standards significantly decreased (p less than 0.001) apparent estriol as detected by radioimmunoassay after separation on dextran-coated charcoal and significantly increased (p less than 0.001) estriol as detected by radioimmunoassay after double-antibody separation. Compensation for individual nonspecific binding of standards nullified the effect of lipids only in systems involving dextran-coated charcoal separation, incubated for 1.0 h at 37 degrees C followed by 1.0 h at 4 degrees C. In contrast to other protocols, data obtained with this system revealed no significant circadian variation in serum estriol concentrations in normal pregnant women (CV, 4.3%). Evidently, reported variations in apparent serum estriol concentration are artifactual.

Circadian Rhythm↗
PubMed1980

Clinical significance of perceptible fetal motion.

The monitoring of fetal activity during the last trimester of pregnancy has been proposed to be useful in assessing fetal welfare. The maternal perception of fetal activity was tested among 82 patients using real-time ultrasonography. All perceived fetal movements were visualized on the scanner and involved motion of the lower limbs. Conversely, 82% of all visualized motions of fetal limbs were perceived by the patients. All combined motions of fetal trunk with limbs were preceived by the patients and described as strong movements, whereas clusters of isolated, weak motions of the fetal limbs were less accurately perceived (56% accuracy). The number of fetal movements perceived during the 15-minute test period was significantly (p < 0.001) greater in pregnancies with ruptured amniotic membranes (9.2 +/- 1.8) than in those with intact membranes (4.2 +/- 0.6). A favorable neonatal outcome was more common (p < 0.01) when recent visualized strong fetal motion was present (44 of 45 cases) than when it was absent (five of 10 cases). These findings reveal that perceived fetal motion is: (1) reliable; (2) related to the strength of lower limb motion; (3) increased with ruptured amniotic membranes; and (4) reassuring if considered to be active.

Female↗
PubMed1980

Coital activity and premature delivery.

The coital activities of 111 patients who delivered after spontaneous premature labor were compared to a matched group of patients who subsequently delivered at term. The percentage of patients who were sexually active, the mean coital frequency, and the incidence of orgasm with coital activity were not significantly different between the two groups. Coital activity in the group delivering prematurely was significantly greater (p less than 0.05) than that in the group delivering at term only when no apparent reason for premature labor (18 or 111 cases) was evident. This relationship was especially true after the thirty-second week of gestation. Normal coital activity does not result in premature delivery and should not be discouraged during pregnancy in the absence of complications.

Coitus↗
PubMed1980

Cervicovaginal cytology in the diagnosis of recurrent carcinoma of the cervix uteri.

The early detection of recurrent carcinoma of the cervix uteri following radiation is essential. This investigation was undertaken to determine the value of cervicovaginal cytologic screening in patients with biopsy proved recurrences. Fifty-six of the 110 patients with a known recurrence had changes on a Papanicolaou smear consistent with suspected or definite malignant cells. The frequency of these positive scrapings was independent of the original cell type, initial clinical staging and interval after completion of radiotherapy. Significantly more smears were positive if there was a central recurrence when compared with a peripheral and distant metastasis. Screening by frequent clinical examination and sampling of exfoliative cervicovaginal cells remain paramount after treatment of carcinoma of the cervix uteri.

Carcinoma↗
PubMed1980

Maternal perception of fetal movement and perinatal outcome.

The maternal perception of fetal activity was studied in 306 clinic patients who counted for 2 predetermined hours each day. "Alarming" and "reassuring" fetal movement patterns were defined from statistical analysis. All reassuring fetal movement patterns were followed by reactive nonstress tests (NSTs), and the 2 nonreactive NSTs were preceded by alarming fetal activity. No relationship between urinary estriol determinations and prior fetal activity was present. Excluding congenital anomalies, perinatal distress was infrequent with prior reassuring fetal activity and arose primarily from intrapartum factors. An alarming fetal movement pattern was twice as frequent in high-risk pregnancies and was associated with a significantly greater risk of subsequent perinatal distress (P less than .0001). Clinical applications of the proposed technique are discussed.

Adult↗