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Biomedical subjects

William F Rayburn

Publications and source records attributed to William F Rayburn.

42 records · Page 3Linked to original sources
PubMed2002

Preinduction cervical ripening: basis and methods of current practice.

The rate of women undergoing labor induction is increasing, primarily because of patient-physician preferences. The widespread availability of preinduction cervical ripening agents has contributed to this rising trend. Approximately half of all women undergoing an induction of labor will have an unfavorable cervix that will require some ripening agent. Pharmacologic and mechanical dilator techniques have been proven to ripen the unfavorable cervix. A topically applied prostaglandin product, containing either dinoprostone or misoprostol, is the most popular means to soften and dilate the cervix. Any uterine hyperstimulation may be reversed by administering a tocolytic drug and, if possible, by removal of the ripening agent. A minimum trial of adequate labor is necessary before considering the induction to be a failure. Cesarean delivery rates may be higher and the length of hospital stay more prolonged. Careful consideration about the need for labor induction is recommended until prospective clinical trials can better validate marginal reasons for cervical ripening.

Cervical Ripening↗
PubMed2002

Effect of labor induction on cesarean section rates in diabetic pregnancies.

OBJECTIVE: To determine if induced labor increases the incidence of cesarean delivery in pregnancies complicated by diabetes. STUDY DESIGN: This retrospective cohort study of pregnancies complicated with diabetes involved data from birth certificates reported to the New Mexico Department of Health between January 1996 and December 1999. RESULTS: There were 108,487 births, with 3,392 (3.1%) in women with diabetes. As compared to those without diabetes, this group had an almost twofold-increased risk of primary cesarean delivery (20.3% versus 11.3%; OR 2.00; 95% CI 1.83, 2.19). The risk of primary cesarean delivery in diabetic women was lower in the presence than in the absence of induced labor (17.7% versus 21.9%; OR .77; 95% CI .50, 0.89). This association continued after controlling for birth weight > or = 4,000 g, breech presentation, twins, maternal age > 35 and gestational age > 42 weeks. CONCLUSION: Induction of labor was not an independent risk factor that could explain the higher cesarean delivery rate in diabetic pregnancies.

Adult↗
PubMedDate not supplied

Sensitivity of over-the-counter pregnancy tests: comparison of utility and marketing messages.

OBJECTIVE: To determine the sensitivity of seven over-the-counter pregnancy tests (OTC-PTs) using urine containing a mixture of human chorionic gonadotropin (hCG)-related molecules as found on the first day of missed menstrual period. DESIGN: Blinded in vitro sensitivity analysis. SETTING: Medical school laboratory. PARTICIPANTS: None. INTERVENTIONS: Urine was tested with OTC-PT devices at titers of 100, 50, 25, 12.5, 6.3, and 0 mIU/mL hCG immunoreactivity, and laboratory workers rated their confidence in the test result based on whether the test result was a clear, sharp, and unquestionable band in the test window. MAIN OUTCOME MEASURES: Analytical sensitivity, defined as the urine concentration at which all OTC-PTs tested gave a positive result regardless of operator confidence score; clinical sensitivity of OTC-PTs, defined as the proportion of pregnancies likely to be detected on the first day of a missed period and calculated from the analytical sensitivity and a recently published regression curve for total urine hCG immunoreactivity in 25 urine samples from this period of gestation; percentage of tested devices showing a band in the test window at a specific hCG concentration measured devices positive; percentage faulty devices, defined as the proportion of tested devices failing to yield a band in the control window; and confidence score, determined from operator ratings for each device at each concentration of hCG. RESULTS: First Response Early Result had an analytical sensitivity of 6.3 mIU/mL, which was estimated to detect greater than 95% of pregnancies on the day of missed period. The sensitivity of Clearblue Easy Earliest Results was 25 mIU/mL, which indicated detection of 80% of pregnancies. The sensitivity of the five other products was 100 mIU/mL or greater, indicating detection of 16% or less of pregnancies. Three of these last products included faulty devices. CONCLUSION: Universal claims for OTC-PTs of more than 99% laboratory accuracy and use as early as the first day of missed period, while cleared for use by the U.S. Food and Drug Administration, are ambiguous and inappropriate for many products, according to these data. The majority of products tested were found to detect only a small percentage of pregnancies on the first day of a missed menstrual period. Until more data become available on the actual clinical sensitivity of these products, pharmacists should advise consumers to be cautious in interpreting test results.

Adult↗
PubMedDate not supplied

Randomized comparison between two microlaparoscopic techniques for partial salpingectomy.

OBJECTIVE: We compared 2 techniques for performing a partial salpingectomy by using microlaparoscopy and either bipolar coagulation or loop ligation. METHODS: A 3-mm transumbilical laparoscope with secondary midline port sites midway and suprapubically was used to perform a partial salpingectomy in 109 women desiring permanent sterilization. Each patient was randomly assigned to undergo a tubal resection either after Pomeroy ligation (n= 54) or after bipolar coagulation with Kleppinger forceps (n=55). Postoperative pain, as assessed using a 10-point visual analog scale, was the primary comparison endpoint. RESULTS: No technical difficulties with either technique required conversion to a minilaparotomy. The mean time to remove both tubal segments was not different between techniques (7 minutes, 21 seconds; range, 4 minutes, 25 seconds to 15 minutes, 43 seconds). Each segment (mean, 1.6 cm; range, 0.8 to 3.5 cm) was confirmed in the operating room, then histologically. Postoperative pain at 6 hours was scored similarly (median, ligation 4.6, coagulation 4.0 of 10). Outpatient recovery was the same, unless pelvic pain required overnight observation (ligation, 4 patients; coagulation, 2 patients). CONCLUSION: Partial salpingectomy, using microlaparoscopy with either bipolar coagulation or loop ligation, was performed with comparable ease, confirmation of the removed tube, and similar postoperative discomfort.

Adult↗