Biomedical subjects

W F Rayburn

Publications and source records attributed to W F Rayburn.

155 records · Page 9Linked to original sources

PubMed1978

A study of fetal acceleration tests.

The fetal acceleration test (FAT) is a means of assessing uteroplacental integrity by observing fetal heart patterns while being stressed by fetal movement. Of 584 tests performed on high-risk obstetric patients, 176 were done within 1 week prior to delivery. Favorable antepartum FAT results correlated with unremarkable initial intrapartum fetal monitor tracings in 128 (97.7 per cent) of 131 cases and also favorable 5 minute Apgar scores (7 to 10) in 128 (97.7 per cent) of 131 cases. An inconclusive FAT correlated with an abnormal OCT or intrapartum monitor tracing in nine of 10 tracings. Two infants with previously abnormal or suspicious FAT, OCT, and intrapartum fetal heart tracings were stillborn. The FAT was also less time-consuming and had fewer complications. These results show the FAT to be an effective clinical test for managing high-risk pregnancies with possible placental insufficiency.

Female↗

PubMedDate not supplied

Influence of intravenous fentanyl on fetal biophysical parameters during labor.

The short-acting opioid fentanyl has been shown to be a useful analgesic during labor. The purpose of this prospective, comparative investigation was to determine whether fentanyl influenced fetal biophysical parameters during labor. Twenty-four uncomplicated pregnancies at 37-41 weeks were studied during the early active phase of labor. Those patients who requested analgesia (study group) were given a standard 50-micrograms dose of fentanyl intravenously. The study (N = 12) and control (N = 12) groups were similar in maternal age, parity, and gestational age distribution. Fetal body and breathing movements and heart rate patterns were evaluated continuously for 80 min at 10-min epochs. Unlike the control group, fetuses exposed to fentanyl had fewer body movements between contractions (P < 0.03) and spent less overall time moving (P < 0.02). Breathing was abolished at 10 min postdosing in all fetuses exposed to fentanyl but not in the control group. The FHR beat-to-beat variability was reduced between contractions for the first 30 min in 8 (66%) of study cases and none of the control cases (P < 0.01). A sine wave-like FHR pattern was observed for 30 min in two fetuses exposed to fentanyl. All infants had 1- and 5-minute Apgar scores > 6, an umbilical artery pH > 7.20, and no need for resuscitation. In conclusion, an intravenous dose of fentanyl during early active labor was associated with temporary depressant effects on many fetal biophysical parameters without apparent harm being observed at delivery.

Analgesics, Opioid↗

PubMedDate not supplied

Effect of antenatal exposure to paroxetine (paxil) on growth and physical maturation of mice offspring.

OBJECTIVE: Our purpose was to determine, in a placebo-controlled manner, whether antenatal exposure to paroxetine affected long-term growth and physical maturation of mice offspring. METHODS: Forty-one CD-1 mice consumed paroxetine (n = 21) or a placebo (n = 20) for 2 weeks before conception and throughout gestation. The daily dose of paroxetine (Paxil; 30 mg/kg/d) was known to achieve concentrations in the serum equivalent to the upper therapeutic level in humans and in the fetal brain equivalent to that of the adult mouse. Growth and physical maturation of the offspring were compared by paired t-test, Welch's corrected test, and Fisher's exact test. RESULTS: The maternal weight gain, litter sizes, number of fetal resorptions, and gestational age at delivery were not different between the paroxetine and the placebo-exposed offspring. Newborn pups exposed to paroxetine were more likely to have low birthweights (1.65 gm vs. 1.70 gm; P < 0.05) and narrower heads (7.7 mm vs. 8.1 mm; P < 0.05). Body weight, body length, and head circumference measurements increased in a manner that was indistinguishable between the two groups of offspring, regardless of gender. No differences in achievement of physical milestones (lower incisor eruption, eye opening, and development of external genitalia) were noted between the two groups. The reproductive capability and the perinatal outcomes of the second-generation offspring were unaffected by paroxetine exposure. CONCLUSION: A clinically relevant dose of paroxetine, when given throughout gestation, did not affect long-term growth and physical maturation of mice offspring.

Aging↗

PubMedDate not supplied

A cost-minimization analysis of intracervical prostaglandin E2 for cervical ripening in an outpatient versus inpatient setting.

This investigation was undertaken to compare the cost impact of prostaglandin E2 gel delivered intracervically in an outpatient versus an inpatient setting. Eligible pregnant women with a singleton gestation that was beyond 37 weeks gestational age and who had an unfavorable cervix (Bishop score < or = 4) received a single dose of 0.5 mg of prostaglandin E2 intracervically as an outpatient or one or more doses as an inpatient the day before a scheduled induction of labor. After gel placement, the outpatient group was monitored for 2 hours with electronic fetal monitoring before being sent home, while the inpatient group was monitored for 2 hours in a labor and delivery unit and then sent to the maternity unit overnight. The outpatient (n = 40) and inpatient (n = 36) groups were not different in terms of maternal age, race, parity, gestational age, maternal weight, predose Bishop score, or indication for delivery. Patients in the outpatient group incurred significantly less costs ($3835.00 +/- 2172.00 vs $5049.00 +/- 2060.00) and time (74.4 +/- 33.1 hours vs 100.3 +/- 41.6 hours) in the hospital than did patients in the inpatient group. Multiparous patients in the outpatient group, compared with those in the inpatient group, spent fewer total hours in the hospital (56.6 +/- 19.3 vs 90.3 +/- 41.0 hours) and had a lower hospital cost ($2891.00 +/- 1236.00 vs $4704.00 +/- 2100.00). The only difference between the nulliparous groups favored outpatient therapy because of less intrapartum expenses ($730.00 +/- 405.00 vs $1036.00 +/- 487.00). There were no differences between the inpatient and outpatient groups for the frequencies of failed inductions, abnormal fetal heart rate patterns, and cesarean sections. No adverse maternal or neonatal effects with therapy were encountered in either setting. Substantial cost savings were found with prostaglandin E2 therapy in an outpatient rather than an inpatient setting for patients who required an induction of labor and were candidates for outpatient cervical ripening.

Administration, Intravaginal↗

PubMedDate not supplied

Chronic prenatal exposure to paroxetine (Paxil) and cognitive development of mice offspring.

This study investigated the impact on cognitive development in CD-1 mice from chronic prenatal exposure to the antidepressant paroxetine. CD-1 mice were given either paroxetine as 30 mg/kg/day or a placebo in food bars for 2 weeks before mating and throughout gestation. One offspring per gender from each litter was tested on each of the following tasks: tube runway, spatial maze, passive avoidance chamber, and water straight runway followed by an unforced decision maze. Learning occurred in both genders in all tasks (p<0.001) with no significant differences between treatment groups at the final learning session. Juvenile runway was the only task in which the paroxetine-exposed males demonstrated a learning rate that was slower than the placebo-exposed offspring (p=0.06). Post learning sessions did not show any significant treatment differences during the juvenile and adult periods during the water straight runway, mazes, and avoidance chamber tasks. In conclusion, chronic prenatal exposure in mice of paroxetine did not impact cognition on select tasks.

Animals↗

PubMedDate not supplied

Impact of hypericum (St.-John's-wort) given prenatally on cognition of mice offspring.

This study investigated the cognitive impact of prenatal exposure to the herbal antidepressant hypericum in CD-1 mice. Hypericum (182 mg/kg/day) or a placebo was consumed in food bars for 2 weeks before mating and throughout gestation. The hypericin content in our hypericum formulation was in the middle range of standardized hypericum products. One offspring per gender from each litter (hypericum 13, placebo 12) was tested on each of the following tasks: juvenile runway with adult memory, adult Morris maze, adult passive avoidance, or adult straight water runway followed by a dry Cincinnati maze. Learning occurred in both genders in all tasks (P<.003) with no significant differences between treatments at the final trial. Female offspring exposed to hypericum, rather than to a placebo, required more time to learn the Morris maze task (P<.05). Postlearning sessions did not show any significant differences. In conclusion, prenatal exposure to a therapeutic dose of hypericum did not have a major impact on certain cognitive tasks in mice offspring.

Animals↗

PubMedDate not supplied

Effect of in utero exposure to betamethasone on motivation/anxiety testing in mice offspring.

In utero exposure to a single dose of the long-acting corticosteroid betamethasone at GD 14 has been shown to induce specific differences in motivation/anxiety testing among offspring. Because multidosings are desired to enhance fetal lung maturation, our objective was to compare effects of multidosings of betamethasone with a placebo on postnatal tests of motivation and anxiety. Sixty gravid CD-1 mice were randomly assigned to receive one of six treatment regimens (n = 10) that consisted of a single or a double SC dosing of either betamethasone (Celestone soluspan 0.2 mg on GD 14; 0.1 mg on GD 13 to 16; 0.1 mg b.i.d. on GD 14 and 15; 0.1 mg b.i.d. on GD 13 to 16) or saline (0.25 ml on GD 13 to 16; 0.25 ml b.i.d. on GD 13 to 16). The percent of pups exhibiting separation vocalization was temporarily less at PND 5 after betamethasone exposure to four doses (p < 0.05) and to eight doses (p < 0.01). The percents of pups being successful in homing (PND 9) and in responding to startle stimulation (PND 12-15) were not different between the betamethasone-exposed and placebo-exposed groups. Exploratory performance in the radial arm maze revealed no delay in the activities of juvenile and adult offspring exposed to betamethasone. The percent of male offspring that fought as juveniles and as adults was not different between the betamethasone-exposed and the placebo-exposed groups. The previously reported altered responses using the elevated plus maze, among juvenile and adult offspring, after a single dose of betamethasone was not replicated in this multidose study. These data indicate that prenatal exposure to betamethasone did not affect the mouse offspring's long-term responses to motivation/anxiety testing.

Animals↗

PubMedDate not supplied

A placebo-controlled, blinded comparison between betamethasone and dexamethasone to enhance lung maturation in the fetal mouse.

OBJECTIVE: To compare the effects of betamethasone and dexamethasone used to enhance lung maturity of the fetal mouse. METHODS: Adult CD-1 mice were administered a single dose of either a placebo or different strengths of betamethasone (0.01, 0.025, or 0.10 mg) or dexamethasone (0.025 or 0.10 mg) on day 14.0 (74%) of gestation. The eight gravid mice in each treatment cohort were killed on day 16.5 to assess fetal lung maturity (histologic changes and respiratory patterns) in a blinded manner. Another ten gravid mice in each treatment group were allowed to deliver spontaneously to assess perinatal outcomes. RESULTS: Compared with the effects from placebo exposure, the 0.10-mg doses of both betamethasone and dexamethasone demonstrated enhanced histologic maturational changes and improved neonatal respiratory efforts. Betamethasone was twofold to threefold more potent than dexamethasone. The fetal crown-rump lengths and the fetal body, lung, and heart weights were indistinguishable among the three treatment groups. Compared with the fetal liver weight in the placebo group (55.0 +/- 2.2 mg), the liver was less heavy after exposure to 0.10 mg of betamethasone (45.6 +/- 2.0 mg; P < .005), 0.025 mg of dexamethasone (47.6 +/- 1.7 mg; P < .02), or 0.10 mg of dexamethasone (43.8 +/- 1.5 mg; P < .001). No significant differences were observed between the 0.10-mg treatments of either corticosteroid and placebo for the duration of gestation, litter size, survival rate, birth weights, or weight gains to postnatal day 26. CONCLUSION: A single subcutaneous dose of 0.10 mg of betamethasone was twofold to threefold more potent than dexamethasone in accelerating fetal lung maturity without impairing fetal survival or weight gain. The unexpected finding of a reduced fetal liver weight with either corticosteroid warrants clinical correlation.

Animals↗

PubMedDate not supplied

Glucocorticoid therapy for rheumatic diseases: maternal, fetal, and breast-feeding considerations.

Glucocorticoids form the mainstay of therapy for many rheumatic diseases, especially systemic lupus erythematosus (SLE). Prednisone is the drug of choice, because it has been well described during the pregnancy and is the primary drug for maintenance therapy or to induce a remission. Principles for prescribing glucocorticoids would apply during pregnancy, recognizing that many effects of rheumatic disease and long-term therapy are similar to physiologic changes of pregnancy. Particular attention should be placed on screening for pregnancy-induced glucose intolerance, hypertension, and delayed fetal growth. Although animal studies suggest an increased risk of oral clefts associated with glucocorticoids, several human studies have failed to demonstrate teratogenic or toxic effects. Nevertheless, rare cases of transient fetal adrenal suppression have been reported, so all infants should be monitored in the nursery. Breast-feeding is safe, with clinically insignificant amounts of the drug being concentrated in breast milk.

Animals↗

PubMedDate not supplied

Comparison of patient-controlled and nurse-administered analgesia using intravenous fentanyl during labor.

Preliminary observations have shown that fentanyl citrate, a potent narcotic, is helpful during labor without undue side effects. This randomized prospective investigation compared the patient-controlled administration of fentanyl with that of administration by nurses on request. Eighty healthy women beginning active labor (cervical dilation 4 cm) at term were assigned to receive fentanyl intravenously by either patient-controlled administration (n=37) or nurse administration on demand (n=43). Pain intensity measurements during early and late labor revealed the degree of analgesia to be the same in both groups. The delay in setting up the infusion system and the short time between requesting analgesia and vaginal delivery were limitations with self-administration. Maternal oversedation and vomiting did not occur. Neonatal naloxone therapy was used infrequently, umbilical serum levels of fentanyl were the same in both groups, and postnatal neuroadaptive testing revealed comparable results in both groups. Despite the usefulness of fentanyl during labor, administration by the patient had no advantages over administration by the nurses in significantly reducing drug use, improving pain relief, or avoiding drowsiness.

Adult↗

PubMedDate not supplied

Combined continuous and demand narcotic dosing for patient-controlled analgesia after cesarean section.

New patient-controlled analgesia devices can deliver an analgesic by continuous infusion along with demand dosing. This prospective investigation involving postcesarean-section patients was undertaken to determine whether a combination of continuous infusion and demand dosing of meperidine would provide more effective analgesia than would demand dosing alone during the first 24 hours. During a 12-month period, 171 patients were prescribed meperidine postoperatively, using a 5- to 10-mg demand dose no more frequently than every 10 minutes. Patients were assigned to groups receiving no continuous infusion or infusion at rates of 10, 20, or 30 mg/h. The groups receiving continuous infusion showed more immediate and sustained pain relief, with no serious complications. All patients were able to understand the nurse, became ambulatory, and tolerated liquids on the first postoperative day. The infusion rate of 20 mg/h was most acceptable in requiring fewer demand doses while providing satisfactory pain relief without undesired sedation. In conclusion, a system combining continuous infusion and demand dosing was preferable to demand dosing alone, and added no apparent hazards.

Adult↗