- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03064152
Rotational Thromboelastometry for the Transfusion Management of Postpartum Hemorrhage After Vaginal or Cesarean Delivery
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Massachusetts
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Boston, Massachusetts, United States, 02115
- Brigham and Women's Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
American Society of Anesthesiologists (ASA) II or III health status (minimal to no systemic disease), age between 18 and 50 yrs, singleton pregnancies admitted for labor and delivery anticipated or actual PPH, or anticipated transfusion of blood products. This will be defined by one or more of the following eligibility criteria:
- Cesarean delivery with moderate or high risk for PPH (see below).
- Cesarean delivery with acute PPH of > 1000 mL and blood products ordered from the blood bank.
- Vaginal delivery with acute PPH of > 500 mL and blood products ordered from the blood bank.
For criterion #1, moderate risk for PPH is defined by one or more of the following features:
- prior cesarean delivery in labor
- prior cesarean delivery with known adhesive disease of the placenta
- multiple gestation
- >4 previous vaginal births
- chorioamnionitis with maternal temperature > 101 degrees Fahrenheit
- history of previous PPH
- large uterine fibroids (> 5 cm)
- second stage of labor (10cm cervical dilation to delivery) > 3 hours
High risk for postpartum hemorrhage is defined by one or more of the following features:
- suspected placenta accreta by pre-delivery ultrasound findings
- placenta previa (current or resolved within 4 weeks of delivery) or low-lying placenta
- active bleeding on admission prior to delivery
Exclusion Criteria:
- known coagulation defect prior to delivery including inherited (hemophilia A, von Willebrand disease, thrombocytopenia, other) or iatrogenic causes (anticoagulation therapy), refusal to accept blood transfusion (Jehovah's Witness, other).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control
Patients who experience postpartum hemorrhage will receive standard of care for labor and delivery, cesarean delivery, and postpartum care.
Transfusion will be based on standard of care utilizing clinical criteria of hemodynamics (noninvasive blood pressure, heart rate, arterial line if deemed clinically useful) and coagulation labs (PT, activated partial thromboplastin time (aPTT), fibrinogen, complete blood count).
In addition to standard of care, additional ROTEM blood assays will be performed at any time routine coagulation labs are sent.
Providers in the control group will be blinded to ROTEM results.
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Experimental: ROTEM
Patients will receive standard of care for labor and delivery, cesarean delivery, and postpartum care.
Transfusion will be based on standard of care utilizing clinical criteria of hemodynamics (noninvasive blood pressure, heart rate, arterial line if deemed clinically useful) and coagulation labs (PT, aPTT, fibrinogen, complete blood count).
In addition to standard of care, additional ROTEM blood assays will be performed at any time routine coagulation labs are sent.
Providers in the ROTEM group will receive real-time ROTEM results and a previously validated ROTEM-based transfusion algorithm for PPH.
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ROTEM is a point-of-care coagulation assay.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Total Blood Products Transfused
Time Frame: t0 = diagnosis of PPH by criteria defined; t final = 48h after onset of PPH.
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Total number of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate, cell salvage units
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t0 = diagnosis of PPH by criteria defined; t final = 48h after onset of PPH.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Blood Loss
Time Frame: From the onset of PPH through 4 hours from leaving the operating room or within 4 hours from the last blood transfusion, whichever occurs later and on average 5 hours.
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Visual estimate in suction canister and sponges, or quantitative blood loss
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From the onset of PPH through 4 hours from leaving the operating room or within 4 hours from the last blood transfusion, whichever occurs later and on average 5 hours.
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Number of Participants With Admission to the Intensive Care Unit
Time Frame: within 2 weeks of delivery
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Need for admission to the intensive care unit after delivery
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within 2 weeks of delivery
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Number of Participants Who Required a Hysterectomy
Time Frame: within 2 weeks of delivery
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Hysterectomy to control postpartum hemorrhage.
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within 2 weeks of delivery
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Number of Participants Who Experienced Maternal Mortality
Time Frame: within 2 weeks of delivery
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Maternal death after delivery.
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within 2 weeks of delivery
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Michaela K Farber, MD MS, Brigham and Women's Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2016P001800
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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