- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04199156
Evaluation of Non-invasive Blood Pressure Measured at the Ankle During Cesarean Delivery Compared to the Arm
Evaluation of the Non-invasive Blood Pressure Measured at the Ankle During Cesarean Delivery Compared to the Arm: a Prospective Observational Study
Spinal anesthesia-induced maternal hypotension during cesarean delivery is hazardous to the mother and the fetus. Prevention of the unfavorable outcomes of maternal hypotension includes various fluid and vasopressor protocols, and requires careful, frequent monitoring of blood pressure during the first 30 minutes after spinal block. Many clinicians set the blood pressure measurement intervals at 1- minute or 2-minutes intervals during the early period after spinal block. it had been reported that hypotension of duration less than 2 minutes is not harmful to the neonate; thus, the minimum inter-measurement intervals for blood pressure readings should be 2 minutes. This high frequency of blood pressure measurements commonly leads to patient dis-satisfaction due to pain as well as impairment of the interaction with the fetus after delivery. Moreover, the blood pressure measurement in the upper limbs could be affected by movement and shivering.
Using the ankle for measurement of non-invasive blood pressure (NIBP) was previously evaluated in normal subjects, and was reported to be feasible; however, its normal range differed from the arm NIBP. Under spinal anesthesia, the lower limb of the mother is neither mobile, nor sensate. Thus, it was previously hypothesized that measurement of blood pressure at the ankle of the mother could improve patient comfort. Darke and Hill had evaluated the accuracy of non-invasive blood pressure at the arm and the ankle during cesarean delivery. Darke and Hill had reported that the degree of bias between the two sites is not acceptable; however, their study did not evaluate the accuracy of ankle NIBP as a trend monitor to trace the changes in maternal blood pressure. The aim of this work is to evaluate the accuracy and precision of ankle NIBP as a trend monitor in mothers undergoing cesarean delivery under spinal anesthesia.
Study Overview
Status
Detailed Description
In the preparation room, the parturient will relax in supine position with left uterine displacement by placing a wedge below the right hip. Appropriate size non-invasive blood pressure (NIBP) cuff for the arm and ankle will be chosen according to arm circumference just proximal to antecubital fossa and ankle circumference just above the malleoli, respectively. The cuff's bladder will be directed anteriorly in the arm and in posteriorly in the leg. Simultaneous NIBP measurement of both arms then both ankles will be done. The arm and the ankle with the higher reading will be used for intraoperative NIBP assessment. The baseline reading of the arm and ankle will be obtained as average of 3 reading 2 minutes apart. Simultaneous arm and ankle NIBP measurement will be every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery. Left uterine displacement will be continued intraoperatively till the delivery. All NIBP measurements will be collected by a research assistant who have no role in parturient management.
Position of the parturient during the spinal anesthesia, drug dosage, fluid management and vasopressor administration will be according to local protocols and the discretion of the attending anesthetist. Intraoperative blood pressure management will be according to the arm NIBP readings
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Cairo, Egypt, 11562
- Kasr Alaini Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- full term singleton pregnant women (18-35 years) scheduled for elective cesarean delivery under spinal anesthesia.
Exclusion Criteria:
- Patients with coarctation of aorta,
- cardiac arrythmia,
- impaired cardiac contractility (ejection fraction< 50%),
- congenital heart disease,
- moderate to severe valvular heart disease,
- uncontrolled hypertension,
- known peripheral vascular disease,
- peripartum bleeding,
- body mass index > 35
- Condition which preclude placement of blood pressure cuff on either limb (lymphedema, high risk of developing lymphedema, local skin damage, known vascular stenotic lesion, deep venous thrombosis)
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
mean bias and agreement between ankle non-invasive blood pressure and arm non-invasive blood pressure
Time Frame: intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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mmHg
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intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The accuracy of ankle systolic blood pressure to diagnose arm absolute systolic hypotension
Time Frame: intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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SBP <90 mmHg and < 100 mmHg
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intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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The accuracy of ankle systolic blood pressure to diagnose arm relative systolic hypotension
Time Frame: intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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20% reduction in arm systolic blood pressure
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intraoperative (every 2 minutes from injection of local anesthetic into subarachnoid space till 5 minutes after delivery, then every 5 minutes till the end of surgery)
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parturient comfort toward arm cuff and ankle cuff
Time Frame: 5 minutes after the surgery
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0= painful, 1=discomfort, 2= comfortable
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5 minutes after the surgery
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arm circumference
Time Frame: 5 minutes before the surgery
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cm
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5 minutes before the surgery
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ankle circumference
Time Frame: 5 minutes before the surgery
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cm
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5 minutes before the surgery
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Collaborators and Investigators
Sponsor
Publications and helpful links
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
Other Study ID Numbers
- MS-269-2019
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
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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