- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00891150
Oxytocin to Decrease Blood Loss During Cesarean Section
Intravenous Oxytocin Use to Decrease Blood Loss During Cesarean Section. What is the Optimal Dose: A Randomized Blinded Trial
Study Overview
Detailed Description
This trial will be a randomized, blinded controlled trial that will be conducted at the American University of Beirut Medical Center Labor and Delivery Unit.
Identification of candidates:
- All women admitted to the Delivery Suite for elective cesarean delivery or needing cesarean delivery for obstetric reasons will be invited to participate in the study.
- Women will then be approached by the research assistants and/or investigators who will explain the objectives of the study and will ask eligible women to participate in the trial and sign a consent form.
Study subjects will be randomized using a computer-generated random number sequence stratified by elective or emergency cesarean section. At surgery, a sealed opaque envelope containing the randomization number and data sheet will be opened for each consenting patient.
Interventions:
Pre-mixed, oxytocin solutions with either 20U/500ml, 30U/500ml or 40U/500ml of Lactated Ringer's solution will be available in the pharmacy department. The bags will be identical in appearance. Each bag will be labeled with a study identification number, from which the pharmacy could determine the administered dose. Subjects as well as the medical providers will be blinded to the assignment of the solution used.
Immediately after delivery of the infant, the study solution will be infused over 30 minutes using a continuous infusion pump (666 mU/min versus 999 mU/min versus 1332mU/min). The placenta will be delivered spontaneously with gentle cord traction. In the postanesthesia care unit, our practice is to give all patients a mixture of 30 U, 20 U and 10U of oxytocin to run consecutively in 1 L of lactated Ringer's solution at a rate of 125 mL/h (41.7 mU/min), which will be continued for a total of 24 hours.
Determination of the need for additional uterotonic agents will be made by the obstetrician and administered and recorded by the anesthesiologist. At the discretion of the surgical team, additional oxytocin could be added to the study solution (eg, 20 U) before requesting methylergonovine, 0.2 mg IM, or 15-methyl prostaglandin F2a 250 mg IM. Intramuscular methylergonovine maleate, and/or carboprost tromethamine will be available in the operating room and will be administered if needed. Ephedrine will be used to treat hypotension after delivery if the systolic blood pressure is >25 mm Hg below baseline.
We will be comparing the mean difference of preoperative hemoglobin vs. postoperative hemoglobin in each group. It will be referred to as delta Hemoglobin (Δ Hb).
In addition, we will be assessing several parameters including uterine tone, volume of blood lost and laparotomy pads number and weight among other data.
We will be performing multiple comparisons among the 3 groups specifically towards our primary outcome which is change or drop in hemoglobin from predelivery to postdelivery level.
The arm of the study with the lowest dose of pitocin and with the least amount of blood loss would probably be the optimal dose needed during a cesarean section for a patient that satisfies all the inclusion criteria of this trial.
In most institutions worldwide, a protocol is usually applied that states how much pitocin should be added to a 1 liter bag of NS or LR during cesarean section. It often ranges from 10 units to 40 units depending on the surgeons preference and uterine tone. The uterus is exteriorized most of the time during the surgery. The uterine tone does play a role in the choice of which dose id to be used(low versus high dose), however the optimal, most efficient dose with the least amount of side effects is yet to be determined. We are aiming to determine the optimal dose that will prevent the obstetricians from the additional use of other uterotonics (methergine, prostaglandins) that carries of by themselves unwanted side effects.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Beirut, Lebanon
- American University of Beirut Medical Center
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Study subjects will be women delivering via an elective cesarean section at term
- All study subjects will have singleton gestation with no obstetric or medical complication.
Exclusion Criteria:
- Laboring women
- Multifetal gestation
- Prolonged oxytocin use (>12 hours)
- Hypertensive disorders
- Chorioamnionitis
- Suspected macrosomia
- Polyhydramnios
- History of postpartum Hemorrhage
- Clotting disorder
- Intake of magnesium sulfate
- Uterine fibroids
- Placenta previa
- Placental abruption
- Anticoagulation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: oxytocin
group 1 will receive oxytocin solutions with 20U/500ml during cesarean section
|
Pre-mixed, oxytocin solutions with either 20U/500ml, 30U/500ml or 40U/500ml of Lactated Ringer's solution will be available in the pharmacy department. The bags will be identical in appearance. Each bag will be labeled with a study identification number, from which the pharmacy could determine the administered dose. Subjects as well as the medical providers will be blinded to the assignment of the solution used. Immediately after delivery of the infant, the study solution will be infused over 30 minutes using a continuous infusion pump (666 mU/min versus 999 mU/min versus 1332mU/min).
Other Names:
|
Active Comparator: oxytocin2
group 2 will receive oxytocin solutions with 30U/500ml during cesarean section
|
Pre-mixed, oxytocin solutions with either 20U/500ml, 30U/500ml or 40U/500ml of Lactated Ringer's solution will be available in the pharmacy department. The bags will be identical in appearance. Each bag will be labeled with a study identification number, from which the pharmacy could determine the administered dose. Subjects as well as the medical providers will be blinded to the assignment of the solution used. Immediately after delivery of the infant, the study solution will be infused over 30 minutes using a continuous infusion pump (666 mU/min versus 999 mU/min versus 1332mU/min).
Other Names:
|
Active Comparator: oxytocin3
group 3 will receive oxytocin solutions with 40U/500ml during cesarean section
|
Pre-mixed, oxytocin solutions with either 20U/500ml, 30U/500ml or 40U/500ml of Lactated Ringer's solution will be available in the pharmacy department. The bags will be identical in appearance. Each bag will be labeled with a study identification number, from which the pharmacy could determine the administered dose. Subjects as well as the medical providers will be blinded to the assignment of the solution used. Immediately after delivery of the infant, the study solution will be infused over 30 minutes using a continuous infusion pump (666 mU/min versus 999 mU/min versus 1332mU/min).
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The change in hemoglobin as a measure of blood loss. The change in hemoglobin is defined as the difference between the predelivery hemoglobin value and the postpartum value
Time Frame: 1 year
|
1 year
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The need for blood transfusion and the use of additional uterotonic agents, pad weight, pad count, estimated blood loss.
Time Frame: 1 year
|
1 year
|
Collaborators and Investigators
Investigators
- Principal Investigator: Labib M Ghulmiyyah, MD, American University of Beirut Medical Center
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- OGY.LB.01
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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