Effect of CPAP on Fetal pH at Scheduled C-section in Morbidly Obese Women

September 17, 2024 updated by: Eastern Virginia Medical School

Effect of Continuous Positive Airway Pressure on Fetal pH at Time of Scheduled Cesarean Delivery in Morbidly Obese Women

The objective of our study is to evaluate the effect of CPAP on umbilical cord acid base status in morbidly obese women at the time of scheduled cesarean delivery. We hypothesize that neonates born to mothers wearing CPAP during the cesarean section will have a higher umbilical artery pH.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This is a randomized control trial comparing CPAP to routine airway management in morbidly obese patients undergoing scheduled cesarean delivery. Morbidly obese women meeting criteria for inclusion will be approached for participation. Women who are scheduled for cesarean delivery at Sentara Norfolk General Hospital will be approached at a prenatal appointment prior to scheduled date of delivery. If a woman agrees to participate in the study, she will be counseled and consented at that time.

Study Type

Interventional

Enrollment (Actual)

66

Phase

  • 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

  • United States
    • Virginia
      • Norfolk, Virginia, United States, 23507
        • Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School

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

Ages Eligible for Study

18 years to 45 years (Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Pregnant women between the ages of 18-45
  • Body mass index of 40 kg/m2 or greater at the time patient is scheduled for cesarean delivery
  • Singleton gestation
  • Scheduled for primary or repeat cesarean delivery at Sentara Norfolk General Hospital
  • Gestational age between 37+0 and 41+0 weeks at the time of delivery
  • Non-stress test on admission with moderate variability, without repetitive late or variable decelerations
  • Negative SARS-CoV-2 PCR test within 72 hours of procedure

Exclusion Criteria:

  • Fetal growth restriction
  • Active pulmonary diseases to include pneumonia, sarcoidosis, pulmonary hypertension, moderate or severe persistent asthma
  • Suspected placenta accreta based on prenatal sonographic evaluation
  • Active maternal infection to include pyelonephritis, appendicitis, upper respiratory tract infection, urinary tract infection or suspected intra-amniotic infection
  • SARS-CoV-2 positive test within past 10 days or ongoing symptoms of SARS-CoV-2 to include cough, fever or shortness of breath with positive test greater than 10 days prior, or history of hospitalization for SARS-CoV-2 infection
  • Fetus with aneuploidy or major anomaly
  • Enrolled in another trial that may affect outcome

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: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Continuous Positive Airway Pressure
Those randomized to CPAP will be fitted with CPAP face mask or nasal device by the respiratory therapist and permitted to trial the machine to ensure proper use and fit. CPAP settings: CPAP AUTO 5-20 cm H20 will be utilized. The CPAP device will then be removed. The subject will then be placed in the supine position with a standard roll placed under the right maternal hip. Those randomized to CPAP will have the device applied and machine turned on. For those randomized to routine airway management, nasal cannula with oxygen 2L/min will be applied and this will be titrated to achieve a maternal SpO2 > 95%. End tidal CO2 monitors will be applied to both patient groups.
Device: CPAP
CPAP is a form of noninvasive positive pressure ventilation (NPPV). CPAP works to maintain adequate levels of PO2 and PCO2 through improved alveolar ventilation and maintenance of upper-airway patency.
Other Names:
  • Continuous Positive Airway Pressure
No Intervention: Nasal Cannula
For those randomized to routine airway management, nasal cannula with oxygen 2L/min will be applied and this will be titrated to achieve a maternal SpO2 > 95%. End tidal CO2 monitors will be applied to both patient groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Umbilical Cord Arterial pH
Time Frame: At delivery
We hypothesize that neonates born to mothers wearing CPAP during the cesarean section will have a higher umbilical artery pH.
At delivery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient satisfaction with use of CPAP
Time Frame: Within 4 days following delivery (prior to discharge from hospital)
Survey will be used to determine patient experience and satisfaction
Within 4 days following delivery (prior to discharge from hospital)
Effect of CPAP on maternal acid base status with analysis of venous blood gas
Time Frame: At time of uterine incision
Maternal venous blood gas will be analyzed at the time of uterine incision to measure the acid base status
At time of uterine incision
Effect of maternal CPAP use on neonatal Apgar scores
Time Frame: At delivery
Apgar scores will be compared between 2 groups
At delivery
Effect of maternal CPAP use on composite neonatal outcome
Time Frame: At delivery
Perinatal death, respiratory support, Apgar score <=3 at 5 min, hypoxic ischemic encephalopathy, hypotension requiring vasopressor support
At delivery
Effect of duration in supine position prior to delivery on neonatal acid base status
Time Frame: At delivery
Neonatal venous blood gas will be analyzed to determine the acid base status as it correlates to length of time in maternal supine position
At delivery
Effect of duration in supine position prior to delivery on maternal acid base status
Time Frame: At delivery
Maternal venous blood gas will be analyzed to determine the acid base status as it correlates to length of time in supine position
At delivery

Collaborators and Investigators

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

Sponsor

Eastern Virginia Medical School

Investigators

  • Principal Investigator: Tracey DeYoung, MD, Eastern Virginia Medical School

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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)

October 11, 2021

Primary Completion (Actual)

May 9, 2023

Study Completion (Actual)

June 30, 2023

Study Registration Dates

First Submitted

June 21, 2021

First Submitted That Met QC Criteria

July 30, 2021

First Posted (Actual)

August 6, 2021

Study Record Updates

Last Update Posted (Actual)

September 19, 2024

Last Update Submitted That Met QC Criteria

September 17, 2024

Last Verified

September 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CPAP on Fetal pH

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

Yes

product manufactured in and exported from the U.S.

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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