- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02243423
Neonatal Acid-Base Status After C Section With Maternal Tilt vs. Supine
Neonatal Acid-base Status After Elective Cesarean Delivery Under Spinal Anesthesia - a Comparison of Maternal Supine Horizontal Position Versus Left Lateral Table Tilt
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Methods: This will be a randomized trial structured as an equivalence trial. Subjects will be American Society of Anesthesiologists (ASA) I and II women aged ≥18 years, non-laboring, at term (>37 weeks gestation) with singleton pregnancies in cephalic presentation, scheduled for elective cesarean delivery under spinal anesthesia. Patients will receive spinal anesthesia for cesarean section in the sitting position, after which they will lay either supine horizontal or the surgical table will be tilted to the left by 15°, depending on the group to which they were randomized (SUPINE or TILT). An IV phenylephrine infusion will be administered to maintain systolic BP at baseline until delivery. A noninvasive hemodynamic monitoring system (NICOM, Cheetah Medical Inc., Vancouver, WA, USA) will continuously monitor CO and stroke volume. Neonatal umbilical vein and arterial blood gas results will be recorded.The null hypothesis is that the position of the patient (supine horizontal or tilted) during cesarean section will make no difference to neonatal wellbeing.
Statistical Design: The estimated sample size is the minimum number of study subjects required for rejecting the alternative hypothesis (i.e., accepting the null hypothesis). A significant difference between groups in the primary outcome, umbilical artery BD (which is a measure of fetal well being at the time of delivery and an indirect indicator of the adequacy of uteroplacental perfusion) would be of the order of magnitude of 2 mmol/L. Standard deviation of BD tends to be of this magnitude also. It would therefore require 22 subjects per group for 90% power to detect this magnitude of difference with alpha 0.05. Because BD is often not normally distributed, it is appropriate to increase sample size by 10-20%, and because the investigators have important secondary outcomes (PE usage, UA and UV pH, UV BD) the investigators intend to recruit 50 subjects per group to allow sufficient power for analysis of these secondary outcomes with appropriate correction for multiple comparisons, and allowing for 10% dropout. PE usage in the investigators previous study tends to have a standard deviation of about 30% of the mean, also roughly the magnitude of a clinically significant difference.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
New York
-
New York, New York, United States, 10034
- New York Presbyterian, Allen Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ASA I and II women aged ≥18 years
- Non-laboring
- At term (>37 weeks gestation) with singleton pregnancies in cephalic presentation
- Scheduled for elective cesarean delivery under spinal anesthesia.
- Maternal height will be between 150 - 180 cm and the body mass index (BMI)≤ 40 kg/m2.
Exclusion Criteria:
- Ruptured membranes
- Severe polyhydramnios or oligohydramnios
- Nonreassuring fetal heart rate
- Intrauterine growth restriction
- Abnormal lie - e.g. breech, transverse lie
- Multiple gestation
- Maternal comorbidities: hypertension, preeclampsia, other cardiovascular disease, renal failure, diabetes mellitus> 10 years, severe scoliosis or kyphosis, uterine abnormalities (e.g. large fibroids, bicornuate uterus)
- Medications - anti-hypertensive agents
- Current smoking or illicit drug use
- Failed spinal (sensory level < T6 after 15 minutes), need to convert to general anesthesia before delivery (exclusion from data analysis
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: SUPINE group
The surgical table will remain horizontal after intrathecal (spinal) anesthesia injection for cesarean section.
Choosing to position the patient supine is the intervention.
|
Patients in the SUPINE group will receive spinal anesthesia for cesarean section in the sitting position, after which they will lay supine horizontal on the surgical table. A phenylephrine intravenous infusion will be titrated according to a set protocol, to maintain the systolic blood pressure at baseline. |
Active Comparator: TILT group
The surgical table will be turned to 15° of left lateral tilt after patients are laid supine after spinal anesthesia injection.
The tilted group is the control group.
|
Patients will receive spinal anesthesia for cesarean section in the sitting position, after which they will lay on the surgical table, which will be tilted to the left by 15°. A phenylephrine intravenous infusion will be titrated according to a set protocol to maintain the systolic blood pressure at baseline. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Base deficit (umbilical artery) (mEq/L)
Time Frame: Within 2 hours of birth
|
The primary outcome will be the neonatal umbilical arterial base deficit at birth.Neonatal umbilical vein and arterial blood gas results (these are routinely sent by the obstetric service at Columbia University Medical Center for all deliveries)
|
Within 2 hours of birth
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total phenylephrine dose (mg)
Time Frame: 15 minutes after spinal injection
|
The secondary outcome will be the total phenylephrine dose requirement at 15 minutes after spinal injection.
The phenylephrine (PE) infusion will be titrated to maintain the systolic arterial pressure (SBP) at baseline.
If the SBP is at or above baseline, no PE will be administered.
If SBP is 90-99% of baseline, PE infusion will be at 50 μg/min.
If the SBP is 80-89% of baseline, PE will be 100 μg/min.
If SBP is less than 80% of baseline, the infusion will be doubled to 200 μg/min.
When SBP returns to more than 90% of baseline, the infusion will be returned to 50 μg/min.
If the SBP remains < 80% of baseline after 1 minute at 200 μg/min, additional boluses of IV phenylephrine 80 μg may be given.
If this regimen is unsuccessful at restoring SBP to >90% of baseline within 3 minutes, any other indicated maneuver may be used.
|
15 minutes after spinal injection
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Richard Smiley, MD, PhD, Columbia University
Publications and helpful links
General Publications
- Lee SW, Khaw KS, Ngan Kee WD, Leung TY, Critchley LA. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth. 2012 Dec;109(6):950-6. doi: 10.1093/bja/aes349. Epub 2012 Oct 11.
- Crawford JS, Burton M, Davies P. Time and lateral tilt at Caesarean section. Br J Anaesth. 1972 May;44(5):477-84. doi: 10.1093/bja/44.5.477. No abstract available.
- Cluver C, Novikova N, Hofmeyr GJ, Hall DR. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD007623. doi: 10.1002/14651858.CD007623.pub3.
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
- AAAO1851
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.
Clinical Trials on Aortocaval Compression
-
Rawalpindi Medical CollegeCompletedHypotension | Cesarean Section | Aortocaval CompressionPakistan
-
AgNovos Healthcare, LLCRecruitingVertebral Compression Fracture | Vertebral Compression | Compression FractureUnited States
-
HypreventionCompletedVertebral Compression FractureFrance
-
University Hospital TuebingenUnknown
-
Stryker InstrumentsTalosixActive, not recruiting
-
Daegu Catholic University Medical CenterCompletedSpinal Compression FractureKorea, Republic of
-
University of VirginiaCook Group Incorporated; ArthroCare Corporation; Cardinal HealthCompletedOsteoporotic Vertebral Compression FracturesUnited States
-
Icahn School of Medicine at Mount SinaiRecruitingVertebral Compression Fractures | Osteoporotic Vertebral Compression FracturesUnited States
-
Wiltrom Co., Ltd.Maxis Medical GmbHRecruitingOsteoporotic Vertebral Compression FracturesGermany
-
National Cheng-Kung University HospitalUnknownCompression Fracture of Thoracic Vertebral Body | Spinal Compression FractureTaiwan
Clinical Trials on SUPINE
-
University of NancyCentral Hospital, Nancy, FranceCompleted
-
Akdeniz UniversityCompletedPreterm Birth | Preterm Infant | Ventilator Lung; NewbornTurkey
-
Hospices Civils de LyonCompleted
-
University Eye Hospital, FreiburgCompletedFuchs' Endothelial DystrophyGermany
-
Hospices Civils de LyonCompleted
-
University of ExeterRoyal Devon and Exeter NHS Foundation TrustCompletedSVT | Vagal BradycardiaUnited Kingdom
-
Osaka UniversityHospital RebagliatiUnknown
-
Milton S. Hershey Medical CenterDysautonomia InternationalCompletedPostural Tachycardia Syndrome | Ehlers-Danlos SyndromeUnited States
-
Changhai HospitalNo.85 Hospital, Changning, Shanghai, ChinaCompleted
-
Dartmouth-Hitchcock Medical CenterCompletedBreast CancerUnited States