The Role of ARTificial Uterine CONtractions in Perinatal Respiratory Morbidity of Term Infants Delivered by Elective Caesarean Section (ARTCON)
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|ClinicalTrials.gov Identifier: NCT03899597|
Recruitment Status : Not yet recruiting
First Posted : April 2, 2019
Last Update Posted : March 24, 2020
|Condition or disease||Intervention/treatment||Phase|
|Neonatal Respiratory Distress||Drug: Oxytocin Other: Normal saline||Not Applicable|
Accumulating evidence suggests that the respiratory morbidity of infants is lower if delivered by caesarean section after the spontaneous onset of uterine contractions, or after oxytocin exposure. Moreover, benefits for the mother due to stretching of the lower uterine segment and possible lower blood loss are plausible.
In obstetrics, there is a well described and standardized way to induce artificial uterine contractions in order to predict fetal wellbeing and tolerance of labor, without inducing the labor itself. This is the oxytocin challenge test (OCT). Although the OCT has not been performed previously in the context of planned elective caesarean section deliveries, it is generally considered a safe procedure if appropriate monitoring is granted. Hence evaluation of the role of artificial uterine contractions in perinatal respiratory morbidity of term infants delivered by elective caesarean section is possible and of interest.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||200 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||A Prospective, Randomized and Placebo Controlled Trial Comparing the Role of ARTificial Uterine CONtractions and no Intervention in Perinatal Respiratory Morbidity of Term Infants Delivered by Elective Caesarean Section - ARTCON Study|
|Estimated Study Start Date :||October 31, 2020|
|Estimated Primary Completion Date :||June 30, 2021|
|Estimated Study Completion Date :||September 30, 2021|
Experimental: artificial contractions (ARTCON) group
All participating patients in the intervention (ARTCON) group will undergo oxytocin exposure in the form of a continuous intravenous infusion according to dosage guidelines of The Czech Society of Obstetrics and Gynaecology. The exposure will take two hours to complete and should be finished at least one hour before elective caesarean section is performed in order for the assumed effects of physiological stress associated with labor to occur.
The intervention group (ARTCON) will receive the standard assignment for the elective caesarean section, but at least one hour before surgery oxytocin exposure will be performed with cardiotocographic (CTG) monitoring and obstetrical supervision.
Placebo Comparator: standard approach (SA) group
All participating patients in the control (SA) group will undergo placebo exposure in the form of a continuous intravenous infusion. The exposure will take two hours to complete and should be finished at least one hour before elective caesarean section is performed.
Other: Normal saline
The control group (SA) will receive the standard assignment for the elective caesarean section, but at least one hour before surgery placebo exposure will be performed with cardiotocographic (CTG) monitoring and obstetrical supervision.
Other Name: Placebo
- Incidence of neonatal respiratory morbidity [ Time Frame: First 24 hours after delivery ]Neonatal respiratory morbidity during the first 24 hours after delivery is defined as presence of transitory tachypnoea of the newborn, or respiratory distress syndrome, and/or persistent pulmonary hypertension of the newborn.
- Oxytocin challenge test effectivity [ Time Frame: Before elective caesarean section ]Contractions being induced (felt or CTG recorded) before elective caesarean section
- Oxytocin challenge test safety and feasibility [ Time Frame: Before elective caesarean section ]CTG trace suggestive of hypoxia during oxytocin exposure. Subjectively unbearable pain and discomfort during oxytocin exposure.
- Maternal blood loss [ Time Frame: During caesarean section ]Defined as the difference in hemoglobin levels before and after surgery
- Total duration of surgery [ Time Frame: Time of caesarean section ]Minutes
- Lamellar body count in amniotic fluid [ Time Frame: During caesarean section ]Particles per microlitre
- Incidence of transitory tachypnoea of the newborn [ Time Frame: First 24 hours after delivery ]Breathing rate above 60 per minute at least for 3 hours (3 consecutive measurements) and /or dyspnoea for at least two hours in the follow-up period (consecutive) and /or the need for oxygen therapy during the first 24 hours after birth.
- Incidence of respiratory distress syndrome [ Time Frame: First 24 hours after delivery ]Defined by need for ventilatory support in the first 24 hours after birth (nasal continuous positive airway pressure, mechanical ventilation) and X-ray examination results consistent with RDS diagnosis.
- Incidence of perinatal hypoxia [ Time Frame: First 24 hours after delivery ]Presence of diagnostic criteria of hypoxic-ischaemic encephalopathy: 5-min Apgar score of less than 5, need for delivery room intubation or CPR, umbilical cord arterial pH less than 7.00 and abnormal neurological signs such as hypotonic muscles or lack of sucking reflex
- Incidence of early onset sepsis [ Time Frame: First 48 hours after delivery ]Clinical or proven (positive blood culture)
- Incidence of significantly increased neonatal pulmonary vascular resistance [ Time Frame: First 72 hours after delivery ]Pulmonary vascular resistance measurements consist of measuring the right ventricular systolic pressure (RVSP), pulmonary artery pressure (PAP) and persistent ductus arteriosus (PDA) shunting (if present).
- Incidence of persistent pulmonary hypertension of the newborn [ Time Frame: First 24 hours after delivery ]Defined by marked pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03899597
|Contact: Ivan Berka, MDfirstname.lastname@example.org|
|Contact: Zbynek Stranak, MDemail@example.com|
|Institute for the Care of Mother and Child|
|Prague, Czechia, 14700|
|Contact: Ivan Berka, MD 0042296511807 firstname.lastname@example.org|
|Principal Investigator:||Ivan Berka, MD||Institute for the Care of Mother and Child, Prague, Czech Republic|