Oxytocin at Elective Cesarean Deliveries: A Dose-finding Study in Women With Twin Pregnancy

January 27, 2022 updated by: Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Postpartum hemorrhage (PPH) due to uterine atony is a major cause of maternal morbidity and mortality. Uterotonic drugs are used to improve the muscle tone of the uterus after birth and these are effective at reducing the incidence of PPH. Large doses of this drug are associated with adverse effects like lower blood pressure, nausea, vomiting, abnormal heart rhythms and changes on ECG. Various international bodies recommend varying and high doses of oxytocin in elective cesarean sections. A study performed at Mount Sinai Hospital showed that a much smaller doses of oxytocin is required (ED95 being 0.35IU). Women who had twins were excluded from this study. It is known that women with a twin pregnancy have a higher risk of poor tone and postpartum hemorrhage.

The investigators seek to find the best dose of oxytocin for the patients with a twin pregnancy. A higher dose may be needed to contract the uterus adequately.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

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.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Canada
    • Ontario
      • Toronto, Ontario, Canada, M5G1X5
        • Mount Sinai Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 50 years (ADULT)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: QUADRUPLE

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
ACTIVE_COMPARATOR: Oxytocin 0.5IU
Patient is given 0.5IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin
ACTIVE_COMPARATOR: Oxytocin 1IU
Patient is given 1IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin
ACTIVE_COMPARATOR: Oxytocin 2IU
Patient is given 2IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin
ACTIVE_COMPARATOR: Oxytocin 3IU
Patient is given 3IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin
ACTIVE_COMPARATOR: Oxytocin 4IU
Patient is given 4IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin
ACTIVE_COMPARATOR: Oxytocin 5IU
Patient is given 5IU of oxytocin intravenously over 1 minute, immediately upon delivery of the fetal head.
Drug: Oxytocin
Oxytocin administered intravenously, over 1 minute following delivery of the fetal head
Other Names:
  • pitocin

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Uterine tone 2 minutes: questionnaire
Time Frame: 3 minutes
Uterine tone, defined as satisfactory or unsatisfactory by the obstetrician at 2 minutes after completion of the oxytocin injection (3 minutes post delivery).
3 minutes

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Intraoperative requirement for additional uterotonic medication
Time Frame: 2 hours
A request made by the obstetrician performing the cesarean delivery for additional uterotonic medication, due to bleeding or poor uterine tone.
2 hours
Hypotension: systolic blood pressure less than 80% of baseline
Time Frame: 2 hours
Systolic blood pressure < 80% of baseline, from drug administration until end of surgery
2 hours
Tachycardia: heart rate greater than 130% of baseline
Time Frame: 2 hours
Heart rate > 130% of baseline, from drug administration until end of surgery
2 hours
Bradycardia: heart rate less than 70% of baseline
Time Frame: 2 hours
Heart rate < 70% of baseline or a heart rate < 50bpm, from drug administration until end of surgery
2 hours
Presence of ventricular tachycardia: ECG
Time Frame: 2 hours
Presence of ventricular tachycardia as recorded by ECG, from drug administration until end of surgery
2 hours
Presence of atrial fibrillation: ECG
Time Frame: 2 hours
Presence of atrial fibrillation as recorded by ECG, from drug administration until end of surgery
2 hours
Presence of atrial flutter: ECG
Time Frame: 2 hours
Presence of atrial flutter as recorded by ECG, from drug administration until end of surgery
2 hours
Presence of nausea: questionnaire
Time Frame: 2 hours
The presence of nausea and number of episodes, from drug administration until end of surgery, as reported by the patient
2 hours
Presence of vomiting: questionnaire
Time Frame: 2 hours
The presence of vomiting and number of episodes, from drug administration until end of surgery
2 hours
Presence of chest pain: questionnaire
Time Frame: 2 hours
Any presence of chest pain, from drug administration until end of surgery, as reported by the patient
2 hours
Presence of shortness of breath: questionnaire
Time Frame: 2 hours
Any presence of shortness of breath, from drug administration until end of surgery, as reported by the patient
2 hours
Presence of headache: questionnaire
Time Frame: 2 hours
Any presence of headache, from drug administration until end of surgery, as reported by the patient
2 hours
Presence of flushing: questionnaire
Time Frame: 2 hours
Any presence of flushing, from drug administration until end of surgery
2 hours
Intravenous fluid administered during surgery
Time Frame: 2 hours
The total volume (ml) of fluid administered from entering the operating room to skin closure.
2 hours
Need for uterine massage: questionnaire
Time Frame: 20 minutes
The obstetricians will be asked if there was any need for uterine massage beyond the initial 3 minute evaluation period following delivery.
20 minutes
Calculated estimate of blood loss
Time Frame: 24 hours

Blood loss will be calculated through the difference in hematocrit values assessed prior to and at the end of 48 hours after the cesarean delivery, according to the following formula:

Calculated blood loss = EBV ((Pre-op Htc-Post-op Htc)/pre-op Htc). EBV (estimated blood volume) in ml: patient's weight in kg x 85
24 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Samuel Lunenfeld Research Institute, Mount Sinai Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
August 6, 2019

Primary Completion (ACTUAL)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 7, 2021

Study Completion (ACTUAL)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 8, 2021

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 17, 2019

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 17, 2019

First Posted (ACTUAL)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 19, 2019

Study Record Updates

Last Update Posted (ACTUAL)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
January 28, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 27, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
January 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 19-03

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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