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W F Rayburn

Publications and source records attributed to W F Rayburn.

At least 19 recordsLinked to original sources
PubMed2004

Chronic prenatal exposure to phenobarbital and long-term behavior effects on mice offspring.

OBJECTIVE: To assess the impact of chronic prenatal exposure to phenobarbital on long-term behavior in mice offspring. METHODS: Twenty-eight C3H/He mice were randomized to receive diet chow containing either a daily therapeutic dose of phenobarbital (2.5 mg in 10-g chow) or a placebo for 1 week before mating and throughout gestation. Offspring from eight litters of each treatment group were evaluated using motor function, arousal/motivation, anxiety-provoking and cognition tasks. RESULTS: No significant differences between groups were found in duration of gestation, litter size and birth weights. Fewer counts in a locomotor chamber were observed in phenobarbital-exposed offspring (524 +/- 31 vs. 688 +/- 54 for 60 min, p < 0.02; 4174 +/- 229 vs. 5230 +/- 406 for 22 h, p < 0.05). Initial reactions to a startle were more apparent among phenobarbital-exposed offspring (p < 0.03). Impaired co-ordination of hindlimbs was observed in the phenobarbital-exposed offspring during the wire maneuver (p < 0.001). Fewer entries into the mirrored chamber were observed after phenobarbital exposure (2.1 vs. 4.5; p < 0.05). Exposure to phenobarbital was not found to affect responses to learning and memory tasks (homing, tube runway, water runway, Morris maze). CONCLUSION: Although cognition was unaffected by prenatal exposure to phenobarbital, subtle effects on locomotor activity, hindlimb co-ordination and responses to anxiety-provoking conditions require human correlation.

Animals↗
PubMed2003

Cross-over trial comparing maternal acceptance of two fetal movement charts.

OBJECTIVE: To compare two daily fetal movement charting techniques to determine which chart was preferred by patients and which promoted more patient adherence. METHODS: This randomized trial included patients with singleton gestations between 28 and 34 weeks' gestation, with intact membranes and not in labor. Consenting women were given a Hollister chart and a 'count to 10' chart in a cross-over manner over two consecutive 1-week periods. Each patient answered a questionnaire establishing which chart was preferred. All returned charts were evaluated for patient adherence. Data were analyzed using either the Yates-corrected chi2 test or Fisher's exact test when appropriate. RESULTS: Forty patients agreed to participate, and 31 completed and returned both charts. The 'count to 10' chart was clearly preferred over the Hollister chart (29 vs. 2; p = 0.002) because of the shorter recording period (median 23 min vs. 1 h; p < 0.01). The proportion of patients who fully completed the 'count to 10' chart during the week was significantly higher than the proportion completing the Hollister chart (68% vs. 26%; p < 0.001). CONCLUSION: The 'count to 10' fetal movement chart was clearly preferred and promoted a higher level of adherence.

Adult↗
PubMed2001

Effect of prenatally administered hypericum (St John's wort) on growth and physical maturation of mouse offspring.

OBJECTIVE: Our purpose was to determine whether prenatal exposure to the herb hypericum (St John's wort) affects long-term growth and physical maturation of mouse offspring. STUDY DESIGN: Forty CD-1 mice were randomly assigned to receive daily doses of either 180 mg/kg per day hypericum (n = 20) or a placebo (n = 20) for 2 weeks before conception and throughout gestation. Perinatal outcomes, growth, and physical milestones of the offspring were compared in a blinded manner. Variables were compared by analysis of variance or by chi2 testing. RESULTS: The gestational ages at delivery and litter sizes did not differ between the hypericum-exposed and the placebo-exposed offspring. The body weight, body length, and head circumference measurements from postnatal day 3 through adulthood increased in a manner that was indistinguishable between the two groups of offspring, regardless of gender. No differences in reaching physical milestones (teeth eruptions, eye opening, external genitalia) were noted between the 2 groups. The reproductive capability, perinatal outcomes, and growth and development of the second-generation offspring were unaffected by hypericum exposure. CONCLUSION: Maternal administration of hypericum before and throughout gestation did not affect long-term growth and physical maturation of exposed mouse offspring.

Animals↗
PubMed2001

Is high-dose misoprostol able to lower the incidence of cesarean section? A randomized controlled trial.

OBJECTIVE: To determine whether high-dose (100 microg) misoprostol was able to increase the rate of successful labor induction and lower the incidence of Cesarean section without adverse fetal effects. METHODS: A total of 360 women were randomized to receive either oxytocin (n = 192) by intravenous infusion, or misoprostol (n = 168) 100 microg intravaginally every 4 h. The Cesarean section rate was the primary end-point. Incidences of uterine and fetal heart rate abnormalities during labor and adverse neonatal outcomes were assessed as secondary end-points. RESULTS: Compared with those women receiving oxytocin, patients given misoprostol had a significantly shortened labor (10.7+/-6.0 vs. 15.4+/-10.4 h, p < 0.001). The Cesarean section rate did not differ between patients receiving misoprostol or oxytocin (36 (21.4%) vs. 38 (19.8%), p = 0.79) despite a sample size adequate to detect a 13 percentage point difference in this outcome. Patients receiving misoprostol had a higher incidence of the hyperstimulation syndrome (27 (16.1%) vs. 9 (4.7%), p < 0.001), and of fetal intolerance of labor as an indication for Cesarean delivery (23 (63.9%) vs. 15 (39.5%), p = 0.06), and had a greater number of umbilical artery cord blood pH findings of< 7.20 (20 (43.5%) vs. 6 (17.1%), p = 0.02). These worrisome trends on interim analysis resulted in our prematurely terminating the study. CONCLUSION: High-dose intravaginal misoprostol did not reduce the Cesarean section rate and was associated with a greater hazard of fetal intolerance of labor.

Administration, Intravaginal↗
PubMed2001

Mandated preterm delivery: its prevalence and impact at a tertiary referral center.

OBJECTIVE: To determine the prevalence and impact of mandated preterm deliveries at a tertiary referral center. METHODS: A chart review was conducted at our institution on all livebirths from 24 weeks to completion of 37 weeks' gestation between 1 January 1998 and 31 December 1999. Mandated delivery was defined as intentional intervention because of a deteriorating maternal or fetal condition. Reasons for intervention and intrapartum courses were compared with two other preterm groups (premature ruptured membranes, spontaneous labor) delivering during the same period. Statistical analyses included the Student t test, univariate ANOVA, X2 test and Mann-Whitney test. RESULTS: A total of 894 pregnancies delivered preterm, with 132 (14.8%) being mandated. Primary reasons for mandated delivery included severe pre-eclampsia (69.0%), vaginal bleeding (11.4%), deteriorating maternal illness (10.6%), worsening fetal growth restriction (6.1%) or major fetal malformation (3.0%). Delivery at less than 34 weeks was more common in the mandated group (68.9%) than in the ruptured membranes group (41.2%, p < 0.005) or in the spontaneous labor group (46.5%; p < 0.01). Cesarean section rates were higher in the mandated group (69.7%) than in the ruptured membranes group (18.3%; p <0.001) or in the spontaneous labor group (21.5%; p < 0.001). The presence of an unfavorable cervix, unsuccessful trial of labor, non-cephalic fetal presentation, or fetal intolerance of labor explained the high rate of surgery. CONCLUSIONS: Conditions mandating delivery accounted for 14.8% of all preterm births. Mandated delivery is associated with a greater need for delivery before 34 weeks, often by Cesarean section.

Analysis of Variance↗
PubMed2001

Multiple courses of antenatal betamethasone and cognitive development of mice offspring.

OBJECTIVE: To measure the effect of multiple courses of antenatal betamethasone, used for lung maturation, on long-term cognition of mice offspring. METHODS: Forty gravid CD-1 mice were randomly assigned to receive one of four treatments (n = 10 per group): 0.1 mg betamethasone or saline placebo, given subcutaneously either once daily on gestational days 13-16 or twice daily on days 14 and 15. This dose of betamethasone given on gestational day 14 causes fetal lung maturation in mice. Three offspring per gender in each litter underwent standard cognitive tasks as juveniles and as adults. Analysis of variance or Kruskal-Wallis testing was used to compare data. RESULTS: Learning acquisition and memory were indistinguishable between the betamethasone-exposed and the corresponding placebo-exposed offspring when performing the following tasks: juvenile runway with adult memory, adult water runway and Morris spatial maze. This lack of difference in task performance between treatment groups persisted after controlling for gender and for each multiple-course regimen. CONCLUSION: Multiple courses of antenatal corticosteroids did not impact the mouse offsprings' long-term learning and memory.

Animals↗
PubMed2001

Placebo-controlled, blinded comparison of antenatal betamethasone on mouse liver development.

The objective of this investigation was to evaluate, in a placebo-controlled manner, the developing mouse liver after antenatal exposure either to a single dose or to a multidose of betamethasone. Ninety gravid CD-1 mice were randomly divided into three groups (n = 30/group) to receive either saline (0.25 mL s.c.) or betamethasone (0.10 mg s.c.) as a single dose on gestational day (GD) 14 of a 19-day gestation or as a 0.10 mg dose given twice daily on GD 14 and on GD 15 (4 doses). GD 0 is defined by the presence of a copulatory plug. These exposures of betamethasone cause fetal mouse lung maturation as would be observed in premature humans at 24-34 weeks of gestation. The livers were removed either from the fetuses on GD 16.5 or from the offspring on postnatal day 1, 3, 5, and 120. Special stains were used to evaluate hepatocyte architecture, glycoprotein and glycogen content, extramedullary hematopoiesis and iron storage. Hepatocyte intranuclear DNA content, cell size, and cell shape were measured by image analysis (CAS 200). At GD 16.5, betamethasone produced a significant decrease in the liver/body weight ratio that, when compared with the placebo group, was greater with the multidose (p < 0.01) than with the single dose (p < 0.05). 16.5 GD single dose hepatocytes were smaller in size as compared to placebo without impact on intranuclear DNA (p < 0.01). Single dose PND 1 hepatocytes demonstrated an increase in intranuclear DNA as compared to placebo but without change in cell size (p < 0.001). The prenatal reduced liver weight recovered in the newborn period. No difference in microscopic architecture of the hepatocytes or histologic differences between either of the three treatment groups was found in glycogen deposition, extramedullary hematopoiesis or iron metabolism at GD 16.5 and postnatally. It was concluded antenatal betamethasone can cause a decrease in the liver/body weight ratio in the fetal mouse that recovers eventually without any functional impact as assessed histologically.

Animals↗
PubMed2001

Early postpartum discharge at a university hospital. Outcome analysis.

OBJECTIVE: To determine whether implementation of an early hospital discharge policy was effective in safely reducing hospital stay and acceptable to patients. STUDY DESIGN: The study was a prospective, observational trial. Early discharge was defined as discharge from the hospital either on the first day after vaginal delivery or on the second day after delivery by cesarean section. A "stayover mom" policy was subsequently implemented to allow a mother the option to remain in the hospital overnight after discharge. This prospective study was divided into three consecutive three-month periods: (1) routine care (n = 576), (2) early discharge (n = 622), and (3) early discharge with stay-over mom (n = 574). Primary outcome measurements were length of hospital stay and patient willingness. RESULTS: With proper review of written instructions, all eligible patients were willing to be discharged early. As compared with the routine care group, the length of hospital stay was shorter by 0.8 days (95% CI, 0.4-1.2 days) in the early discharge group (P < .01) and by 1.1 days (95% CI, 0.5-1.7 days) in the early discharge with stayover mom group (P < .005). The stayover mom policy was more desirable because of limitations in obtaining timely transportation and concern about the infant warranting continued observation. The need for maternal readmission was rare (15 cases, 0.8% of total), with endometritis equally common (n = 3 in each group). CONCLUSION: Early postpartum discharge, especially including a stayover mom policy, was acceptable to our predominantly Medicaid population. The reduced hospital stay was not associated with increased maternal morbidity.

Female↗
PubMed2001

Outpatient cervical ripening using a sustained-release prostaglandin E2 vaginal insert.

This clinical trial was undertaken to determine whether a sustained-release prostaglandin E2 vaginal insert could be used for outpatient cervical ripening. A total of 111 patients, with primarily pregnancy-induced hypertension or postdatism, were administered the insert in a simulated outpatient setting. The high rates of regular contractions (23.4%) and of removal of the insert before < 12 hours (27.9%) make its use undesirable outside a hospital.

Adolescent↗
PubMed2001

Microlaparoscopic technique for partial salpingectomy using bipolar electrocoagulation.

OBJECTIVE: To describe a technique of performing a partial salpingectomy using a small-diameter (2-mm) laparoscope and bipolar electrocoagulation. STUDY DESIGN: Sixty consecutive women desiring permanent sterilization underwent laparoscopic partial salpingectomy using a 2-mm transumbilical laparoscope and secondary midline sites suprapubically and midway above the pubis. A midportion of the tube was coagulated using Kleppinger forceps, transected with scissors and removed using grasping forceps. RESULTS: Additional time to remove both coagulated tubal segments averaged 4 minutes (range, 3-10). Each segment (mean, 1.5 cm; range, 0.9-2.4 cm) was confirmed in the operating room, then histologically. The transected tubal edges were separated with no thermal injury to nearby structures and with no mesosalpingeal hemorrhage. No cases required conversion from microlaparoscopy to a traditional method, and recovery time was not prolonged. The puncture sites healed well without sutures. CONCLUSION: Successful removal of electrocoagulated tubal segments with histologic confirmation was undertaken microlaparoscopically, with minimal additional operative time.

Adult↗
PubMed2000

Effect of antenatal exposure to Saint John's wort (Hypericum) on neurobehavior of developing mice.

OBJECTIVE: We conducted, in a randomized, placebo-controlled manner, behavioral testing on mice offspring exposed antenatally to the herbal antidepressant Saint John's wort (Hypericum ). STUDY DESIGN: A daily dose of Saint John's wort (0.75 mg/g of food consumed), equivalent to that in human beings according to body surface, was chosen because it has been shown to cause an antidepressant effect in adult mice. CD-1 mice were randomly assigned to consume either Saint John's wort (n = 45) or a placebo (n = 45) for 2 weeks before conception and throughout gestation. Behavioral testing consisted of early developmental tasks of geotaxis, separation vocalization, and homing, followed by motor, anxiety, and depression assessments into adulthood. RESULTS: Birth weights of male offspring were less in the Saint John's wort group than in the placebo group (1.68 vs. 1.75 g; P<.01). Offspring in both treatment groups showed no long-term statistical differences in early developmental tasks, locomotor activity, and exploratory behavior throughout development. Performances on a depression task (forced swim) and on anxiety tasks (elevated plus maze as juveniles and adults) revealed no differences between treatment groups. CONCLUSION: Antenatal exposure to a therapeutic dose of Saint John's wort showed no long-term deficits on selected behavioral tasks by developing mice offspring.

Animals↗
PubMed2000

Impact of antenatal exposure of mice to fenfluramine on cardiac development and long-term growth of the offspring.

The objective of this investigation was to determine, in a placebo-controlled manner, whether antenatal exposure to formulations of fenfluramine and dexfenfluramine impacted cardiac development and long-term growth of exposed mice offspring. One hundred forty-four CD-1 mice were randomized to six treatment groups (n=23 or 25) to obtain, per group, 5 gravids for killing on gestational day (GD) 15 and < or =10 deliveries for assessing growth of the offspring. Either fenfluramine preparation was administered in feed bars in two doses: 1 and 3.2 times the equivalent human daily dosage according to body surface area. The drugs were given from 2 weeks before mating until GD 15. The mice ingested each drug at target values, averaging 10.5+/-0.3 and 31.8+/-1.9 mg/kg/d for fenfluramine and 5.0+/-0.2 and 16.2+/-0.4 mg/kg/d for dexfenfluramine. The drug concentration was about 36% in the fetal brain compared with the adult brain. The maternal and the offspring hearts, including mitral and aortic valves, of fenfluramine-exposed mice were indistinguishable from the placebo-exposed mice. The duration of gestation and the litter size were the same between the treatment groups. The mean body weights, body lengths, and head circumferences and early functional testing did not differ significantly between the fenfluramine or dexfenfluramine-exposed offspring and the placebo-exposed offspring. There were no significant treatment differences in growth measured as body weights to PND 120. Neither fenfluramine formulation, given before conception and during gestation, impacted cardiac development and long-term growth of the mice offspring.

Abnormalities, Drug-Induced↗
PubMed2000

Indications for labor induction. Differences between university and community hospitals.

OBJECTIVE: To compare the rates of and indications for labor induction between a university hospital and two community hospitals and to examine the risk of cesarean delivery among labor induction cases. STUDY DESIGN: Labor induction cases over a six-month period were included (N = 536). Medical records were reviewed by a trained abstractor using a standardized form to determine maternal characteristics, reason for induction and perinatal outcomes. RESULTS: Rates of labor induction were significantly different between the three hospitals: university, 18.2%; community hospital A, 21.4%; community hospital B, 33.7% (P < .001). At the university hospital, 95% of labor inductions were medically indicated using American College of Obstetricians and Gynecologists (ACOG) criteria. Forty-four percent of labor inductions at community hospital A and 57% at community hospital B were for elective reasons. Cesarean rates among induction cases were highest at the university hospital (19%) as compared to community hospital A (15%) and community hospital B (11%), although the difference was not statistically significant. Parity, race and cervical status, but not elective induction, were significantly associated with cesarean delivery. CONCLUSION: Labor induction was more frequent in community hospitals but more likely to meet ACOG-approved indications at the university hospital. The more-frequent inductions at the community hospitals did not result in higher cesarean rates.

Adult↗
PubMed2000

Blastocyst transfer in human in vitro fertilization. A solution to the multiple pregnancy epidemic.

Since the 1950s, the incidence of twin gestation has doubled and the incidence of triplets has increased approximately sevenfold in the United States. Of extreme concern is the fact that many of these multiple pregnancies are iatrogenic: 35% of twin gestations and 77% of higher-order pregnancies are the result of some form of infertility therapy. Anything that can be done to reduce the number of these multiple pregnancies would benefit our patients and society. Great hope is placed on emerging blastocyst technology, which has the potential of achieving higher pregnancy rates per embryo transfer while reducing the risk of multiple pregnancy. We present the evolution of the blastocyst transfer concept and the technical aspects involved. The article also outlines the experience with blastocyst culture and transfer at Brigham and Women's Hospital, Boston, and describes identifiers for application of blastocyst transfer. The number of eight-cell embryos on day 3 is an independent marker for the selection of patients who would benefit from transfer on day 5. With no eight-cell embryos on day 3, 0% and 33% pregnancies resulted from day 5 vs. day 3 transfers, suggesting that these cases would not benefit from day 5 transfer. When at least one eight-cell embryo is available, there is no difference in ongoing pregnancy rates between day 5 and day 3 transfers, but there is a significant decrease in multiple gestations with day 5 transfers.

Adult↗
PubMed1999

Behavioral changes in developing mice after prenatal exposure to paroxetine (Paxil)

OBJECTIVE: The aim of this study was to conduct in a randomized, placebo-controlled manner behavioral testing on mice offspring exposed prenatally to the selective serotonin reuptake inhibitor paroxetine. STUDY DESIGN: Forty-one CD-1 mice consumed paroxetine (Paxil, n = 21) or a placebo (n = 20) for 2 weeks before conception and throughout gestation. The daily dose of paroxetine used, 30 mg x kg(-1) x d(-1), is known to achieve concentrations in the rat serum equivalent to the upper therapeutic level in human beings and to achieve concentrations in the fetal rat brain equivalent to those in the adult mouse. Behavioral testing consisted of multiple tasks during early development, followed by motor, anxiety, reproduction, and depression tasks in the juvenile and adult periods. RESULTS: Offspring in the 2 treatment groups showed no statistical differences in many early development tasks (geotaxis, homing, social play) or in locomotor and exploratory activities throughout development. Performances during a depression task (forced swim), anxiety tasks (elevated plus maze as juveniles and adults), and reproduction revealed no treatment differences. Offspring exposed prenatally to paroxetine had a 15% to 25% increase in separation vocalization (P <.04) and a significant increase in male aggression during cage changing (P <.03). CONCLUSION: Prenatal exposure to a clinically relevant dose of paroxetine in mice produced no major behavioral alterations but did heighten performance on select anxiety testing in infant offspring and on aggressive behavior in adult males.

Aggression↗
PubMed1999

Prior third- or fourth-degree perineal tears and recurrence risks.

OBJECTIVE: The objective of the present study is to determine the recurrence risk of a third-degree (into the anal sphincter) or a fourth-degree (into the rectum) perineal tear in women with a prior extensive laceration. METHODS: Data were gathered from our computerized perinatal database between January 1990 and December 1994. Women who had two consecutive singleton deliveries were chosen as subjects. RESULTS: The rate of an extensive perineal laceration was greater if a tear had occurred in a previous pregnancy (19 of 178 cases, 10.7% vs. 56% of 1563 cases, 3.6%, odds ratio 3.4. A 95% confidence interval: 1.8-6.4; p < 0.0001). A prior tear remained a risk factor after controlling for other variables (epidural analgesia, episiotomy, oxytocin use, operative vaginal delivery, fetal macrosomia). CONCLUSION: A prior third-degree or fourth-degree perineal tear is associated with a 3.4-fold increased risk of a recurrent severe obstetrical laceration.

Adolescent↗