Oxytocin at Elective Cesarean Deliveries: A Dose-finding Study in Women With Twin Pregnancy
Paraules clau
Resum
Descripció
Postpartum hemorrhage (PPH) is one of the leading causes of death during childbirth and accounts for an estimated 140,000 deaths per year worldwide. Furthermore, recent evidence has shown that the rate of PPH secondary to uterine atony is increasing.
Multiple pregnancy is a well-recognized risk factor for PPH. Compared with singleton pregnancy, women with a multiple pregnancy have an increased risk of PPH, severe PPH, transfusion, uterine atony, hysterectomy, prolonged hospital stay and death. This is true in both high- and low-income countries. Uterine atony as a cause of PPH is more likely in multiple pregnancy compared with singleton pregnancy.
Prophylactic uterotonic drugs administered after the delivery have been demonstrated to reduce the incidence of PPH by up to 40%. Oxytocin is the most commonly administered uterotonic drug used to prevent PPH in North America but is associated with adverse effects such as hypotension, nausea, vomiting, dysrhythmias, ST segment abnormalities, and severe water intoxication that may lead to pulmonary edema and convulsions.
Previous dose finding studies have excluded women with twin pregnancies. Therefore, the investigators wish to perform a double blinded dose finding study using the biased coin flip up-and-down sequential allocation technique to determine the ED 90 of oxytocin at cesarean section in those women with a twin pregnancy.
Dates
Darrera verificació: | 02/29/2020 |
Primer enviat: | 07/16/2019 |
Inscripció estimada enviada: | 07/16/2019 |
Publicat per primera vegada: | 07/18/2019 |
Última actualització enviada: | 03/18/2020 |
Publicació de l'última actualització: | 03/19/2020 |
Data d'inici de l'estudi real: | 08/05/2019 |
Data estimada de finalització primària: | 11/30/2020 |
Data estimada de finalització de l’estudi: | 11/30/2020 |
Condició o malaltia
Intervenció / tractament
Drug: Oxytocin
Fase
Grups de braços
Braç | Intervenció / tractament |
---|---|
Active Comparator: Oxytocin 0.5IU Patient is given 0.5IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. | |
Active Comparator: Oxytocin 1IU Patient is given 1IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. | |
Active Comparator: Oxytocin 2IU Patient is given 2IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. | |
Active Comparator: Oxytocin 3IU Patient is given 3IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. | |
Active Comparator: Oxytocin 4IU Patient is given 4IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. | |
Active Comparator: Oxytocin 5IU Patient is given 5IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head. |
Criteris d'elegibilitat
Edats elegibles per estudiar | 18 Years Per a 18 Years |
Sexes elegibles per estudiar | Female |
Accepta voluntaris saludables | Sí |
Criteris | Inclusion Criteria: - Twin pregnancy - Elective cesarean delivery under regional anesthesia - Gestational age ≥36 weeks - No known additional risk factors for postpartum hemorrhage - Written informed consent to participate in this study Exclusion Criteria: - Refusal to give written informed consent - Allergy or hypersensitivity to oxytocin - Conditions that may predispose to uterine atony and postpartum hemorrhage such as placenta previa, severe preeclampsia (as defined by SOGC guidelines (25)), polyhydramnios, uterine fibroids, previous history of uterine atony resulting in PPH, or bleeding diathesis and obesity, defined as pre-pregnancy BMI >40 - Hepatic, renal, and vascular disease - Use of general anesthesia prior to the administration of the study drug |
Resultat
Mesures de resultats primaris
1. Uterine tone 2 minutes: questionnaire [3 minutes]
Mesures de resultats secundaris
1. Need for uterine massage: questionnaire [20 minutes]
2. Intraoperative requirement for additional uterotonic medication [2 hours]
3. Calculated estimate of blood loss [24 hours]
4. Intravenous fluid administered during surgery [2 hours]
5. Hypotension: systolic blood pressure less than 80% of baseline [2 hours]
6. Tachycardia: heart rate greater than 130% of baseline [2 hours]
7. Bradycardia: heart rate less than 70% of baseline [2 hours]
8. Presence of ventricular tachycardia: ECG [2 hours]
9. Presence of atrial fibrillation: ECG [2 hours]
10. Presence of atrial flutter: ECG [2 hours]
11. Presence of nausea: questionnaire [2 hours]
12. Presence of vomiting: questionnaire [2 hours]
13. Presence of chest pain: questionnaire [2 hours]
14. Presence of shortness of breath: questionnaire [2 hours]
15. Presence of headache: questionnaire [2 hours]
16. Presence of flushing: questionnaire [2 hours]