Oxytocin in Cesarean Delivery
Recruitment status was Not yet recruiting
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Purpose
In this study the investigators hypothesize that infused combinations of oxytocin and ergometrine will exhibit fewer cardiac and neurological side effects than equipotent infusion of oxytocin alone. In order to perform this study the investigators perform the following steps:
- The investigators validate a quantitative measure of uterine tone as our primary endpoint.
- The investigators use this endpoint measure in order to determine equipotential doses of different tocotonic drug regimens, based on the ED50 for each.
- Using equipontial ratios based on the ED50, the investigators compare hemodynamic and other side effects of these tocotonic drug regimes. Plasma levels of oxytocin will be measured.
| Condition | Intervention | Phase |
|---|---|---|
|
Post Partum Hemorrhage |
Drug: Oxytocin versus oxytocin-ergometrine |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Pharmacokinetics/Dynamics Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | Comparing Oxytocin and Oxytocin-ergometrine Combinations for Increasing Uterine Tone in Cesarean Delivery: a Pharmacokinetic-pharmacodynamic Study. |
- Uterine tone [ Time Frame: Up to 30 minutes ] [ Designated as safety issue: No ]Uterine tone as measured by tissue durometry
- Plasma levels of oxytocin [ Time Frame: Up to 30 minutes ] [ Designated as safety issue: No ]
- Subjective side effects [ Time Frame: Up to 120 minutes ] [ Designated as safety issue: Yes ]Headache, chest pain, shortness of breath
| Estimated Enrollment: | 80 |
| Study Start Date: | November 2010 |
| Estimated Study Completion Date: | May 2011 |
| Estimated Primary Completion Date: | May 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
| Active Comparator: Oxytocin |
Drug: Oxytocin versus oxytocin-ergometrine
Group 1: Oxytocin 0.1 I.U./kg/hr (plain) Group 2: Oxytocin 0.1 I.U./kg/hr with ergometrine 2 mcg/kg/hr co-administered Infusion rates determined to achieve equipotential doses based on an earlier PKPD study
|
| Experimental: Oxytocin - ergometrine |
Drug: Oxytocin versus oxytocin-ergometrine
Group 1: Oxytocin 0.1 I.U./kg/hr (plain) Group 2: Oxytocin 0.1 I.U./kg/hr with ergometrine 2 mcg/kg/hr co-administered Infusion rates determined to achieve equipotential doses based on an earlier PKPD study
|
Detailed Description:
Obstetric hemorrhage is associated with severe maternal morbidityש and maternal death. The use of tocotonic drugs following delivery is routine practice as part of the active management of the third stage of labor, to increase uterine tone and reduce blood loss. However, the use of these drugs is not without side effects and complications. Oxytocin causes profound vasodilatation, hypotension and increased cardiac output and has been associated with chest pain, reduced arterial oxygen saturation and ST segment changes on ECG. Ergometrine, on the other hand, causes systemic vasoconstriction and hypertension, and reduced cardiac output. As oxytocin and ergometrine are associated with opposing hemodynamic sequelae, there is a rationale to justify the co-administration of both of these drugs in an attempt to cancel out their side effects.
No clinical studies have attempted to titrate the dose of tocotonic drugs against a quantified measure of uterine tone. As a consequence, comparisons of the hemodynamic side effects of oxytocin and other tocotonic agents (particularly ergometrine) have not been based on a knowledge of equipotential doses, making the rational comparison of side effects impossible.
In this study we hypothesize that infused combinations of oxytocin and ergometrine will exhibit fewer cardiac and neurological side effects than equipotent infusion of oxytocin alone. In order to perform this study we perform the following steps:
1) We validate a quantitative measure of uterine tone as our primary endpoint. 2) We use this endpoint measure in order to determine equipotential doses of different tocotonic drug regimens, based on the ED50 for each. 3) Using equipontial ratios based on the ED50, we compare hemodynamic and other side effects of these tocotonic drug regimes. Plasma levels of oxytocin will be measured to enable pharmacokinetic-pharmacodynamic assessments to be made.
Eligibility| Ages Eligible for Study: | 18 Years to 45 Years |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- 80 healthy women presenting for elective repeat cesarean delivery under regional anesthesia.
- All women are ASA class 1-2, aged 18 - 45, with body weight 60-100 kg.
Exclusion Criteria:
- Obstetric risk factors: Pre-eclampsia, abnormalities of placentation (eg placenta accrete, placenta previa), amnionitis, multiple gestation, preterm delivery (< 37 completed weeks), more than three previous cesarean deliveries, previous history of ante-partum or post-partum hemorrhage.
- Maternal medical risk factors: Chronic hypertension, cardiac disease, intracranial pathology, known allergies to oxytocin or ergometrine, autoimmune disorders, SLE, coagulation defect or anticoagulation therapy, amnionitis.
- Women asking for cord blood donations are not included in this study due to the long elapsed time between delivery and the commencement of oxytocin.
Contacts and Locations| Israel | |
| Hadassah Hebrew University Medical Center | Not yet recruiting |
| Jerusalem, Israel, 93510 | |
| Contact: Yehuda Ginosar, MBBS +972-2-6722077 yginosar@netvision.net.il | |
| Principal Investigator: Yehuda Ginosar, MBBS | |
More Information
No publications provided
| Responsible Party: | Yehuda Ginosar, Hadassah Hebrew University Medical Center |
| ClinicalTrials.gov Identifier: | NCT01236482 History of Changes |
| Other Study ID Numbers: | oxytocined50-HMO-CTIL |
| Study First Received: | September 27, 2010 |
| Last Updated: | November 5, 2010 |
| Health Authority: | Israel: Ministry of Health |
Keywords provided by Hadassah Medical Organization:
|
Pregnancy Postpartum hemorrhage Uterine tone |
Oxytocin Ergometrine Pharmacokinetic-pharmacodynamic analysis |
Additional relevant MeSH terms:
|
Hemorrhage Postpartum Hemorrhage Pathologic Processes Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage |
Ergonovine Oxytocin Oxytocics Reproductive Control Agents Physiological Effects of Drugs Pharmacologic Actions Therapeutic Uses |
ClinicalTrials.gov processed this record on May 23, 2013