Combined Colloids And Crystalloids Versus Crystalloids in Women With Preeclampsia Undergoing Cesarean Delivery

NCT ID: NCT03252496

Last Updated: 2021-09-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-08-19

Study Completion Date

2021-07-15

Brief Summary

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This study will compare between combination of colloids/crystalloids and crystalloids in women with preeclampsia undergoing elective cesarean delivery under spinal anesthesia

Detailed Description

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This randomized, controlled, double blind study will be conducted on women with preeclampsia with singleton pregnancy undergoing elective cesarean delivery under spinal anesthesia. Immediately, after spinal anesthesia administration, patients will receive either 250 mL colloid over 5 minutes followed by 500 mL crystalloid over 55 minutes then 250 mL colloid over 60 minutes (Combination group) or 250 mL crystalloid over 5 minutes followed by 500 mL over 55 minutes then 250 mL over 60 minutes (Crystalloid group). The studied maternal outcomes will be the urine output, ephedrine requirement, incidence of hypotension, inferior vena cava diameters, nausea/vomiting and bradycardia. Neonatal Apgar scores will be recorded at 1 and 5 minutes post-delivery.

Conditions

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Pre-Eclampsia Cesarean Section

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Combination

250 mL colloid over 5 minutes followed by 500 mL crystalloid over 55 minutes then 250 mL colloid over 60 minutes. Cesarean delivery performed under spinal anesthesia (intrathecal bupivacaine 12.5 mg and intrathecal fentanyl 15 μg). Ultrasound assessment of the Inferior vena cava diameter. Intravenous ephedrine and intravenous syntocinon will be administered.

Group Type EXPERIMENTAL

Spinal Anesthesia

Intervention Type PROCEDURE

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intrathecal Bupivacaine

Intervention Type DRUG

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intrathecal Fentanyl

Intervention Type DRUG

Fentanyl 15 μg will be administered in the subarachnoid space

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision

Ultrasound Assessment of the Inferior Vena Cava

Intervention Type RADIATION

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 8-2 MHz curved array ultrasound probe placed longitudinally in the subcostal region

250 mL Colloid over 5 minutes

Intervention Type DRUG

6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 250 mL will be administered over 5 minutes starting immediately after intrathecal injection

500 mL Crystalloid over 55 minutes

Intervention Type DRUG

Ringer acetate 500 mL will be administered over 55 minutes following colloid or crystalloid administration

250 mL Colloid over 60 minutes

Intervention Type DRUG

After 60 minutes of intrathecal injection, 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 250 mL will be administered over 60 minutes

Intravenous Ephedrine

Intervention Type DRUG

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 120, 110, and 90 mmHg, respectively.

Intravenous Syntocinon

Intervention Type DRUG

Immediately after delivery, syntocinon 10 IU will be added to the running crystalloid solution

Crystalloid

250 mL crystalloid over 5 minutes followed by 500 mL crystalloid over 55 minutes then 250 mL crystalloid over 60 minutes. Cesarean delivery performed under spinal anesthesia (intrathecal bupivacaine 12.5 mg and intrathecal fentanyl 15 μg). Ultrasound assessment of the Inferior vena cava diameter. Intravenous ephedrine and intravenous syntocinon will be administered.

Group Type ACTIVE_COMPARATOR

Spinal Anesthesia

Intervention Type PROCEDURE

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intrathecal Bupivacaine

Intervention Type DRUG

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intrathecal Fentanyl

Intervention Type DRUG

Fentanyl 15 μg will be administered in the subarachnoid space

Cesarean Delivery

Intervention Type PROCEDURE

Lower segment cesarean section using the Pfannenstiel incision

Ultrasound Assessment of the Inferior Vena Cava

Intervention Type RADIATION

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 8-2 MHz curved array ultrasound probe placed longitudinally in the subcostal region

250 mL Crystalloid over 5 minutes

Intervention Type DRUG

Ringer acetate 250 mL will be administered over 5 minutes starting immediately after intrathecal injection

500 mL Crystalloid over 55 minutes

Intervention Type DRUG

Ringer acetate 500 mL will be administered over 55 minutes following colloid or crystalloid administration

250 mL Crystalloid over 60 minutes

Intervention Type DRUG

After 60 minutes of intrathecal injection, Ringer acetate 250 mL will be administered over 60 minutes

Intravenous Ephedrine

Intervention Type DRUG

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 120, 110, and 90 mmHg, respectively.

Intravenous Syntocinon

Intervention Type DRUG

Immediately after delivery, syntocinon 10 IU will be added to the running crystalloid solution

Interventions

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Spinal Anesthesia

Performed at the L3-L4 or L4-L5 interspace using 27- or 25-gauge spinal needle

Intervention Type PROCEDURE

Intrathecal Bupivacaine

Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space

Intervention Type DRUG

Intrathecal Fentanyl

Fentanyl 15 μg will be administered in the subarachnoid space

Intervention Type DRUG

Cesarean Delivery

Lower segment cesarean section using the Pfannenstiel incision

Intervention Type PROCEDURE

Ultrasound Assessment of the Inferior Vena Cava

The inferior vena cava largest and smallest diameters will be measured proximal to the opening of the hepatic veins in the longitudinal axis with the M-mode using a 8-2 MHz curved array ultrasound probe placed longitudinally in the subcostal region

Intervention Type RADIATION

250 mL Colloid over 5 minutes

6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 250 mL will be administered over 5 minutes starting immediately after intrathecal injection

Intervention Type DRUG

250 mL Crystalloid over 5 minutes

Ringer acetate 250 mL will be administered over 5 minutes starting immediately after intrathecal injection

Intervention Type DRUG

500 mL Crystalloid over 55 minutes

Ringer acetate 500 mL will be administered over 55 minutes following colloid or crystalloid administration

Intervention Type DRUG

250 mL Colloid over 60 minutes

After 60 minutes of intrathecal injection, 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (voluven®) 250 mL will be administered over 60 minutes

Intervention Type DRUG

250 mL Crystalloid over 60 minutes

After 60 minutes of intrathecal injection, Ringer acetate 250 mL will be administered over 60 minutes

Intervention Type DRUG

Intravenous Ephedrine

Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 120, 110, and 90 mmHg, respectively.

Intervention Type DRUG

Intravenous Syntocinon

Immediately after delivery, syntocinon 10 IU will be added to the running crystalloid solution

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Preeclampsia: Blood Pressure ≥140/90 mmHg after 20 weeks' gestation and proteinuria ≥300 mg/24 hours or 1+ on urine dipstick
* Singleton pregnancy
* Elective cesarean delivery under spinal anesthesia

Exclusion Criteria

* Height \<150 cm
* Weight \<60 kg
* Body mass index ≥45 kg/m2
* Women presenting in labor
* Contraindications to spinal anesthesia (increased intracranial pressure or local skin infection)
* Diabetes mellitus, cardiovascular, cerebrovascular, or renal disease
* Preoperative administration of intravenous hydralazine or magnesium sulphate
* Hemoglobin \<10 gm/dL
* International Normalized Ratio \>1.3
* Platelet count \<100,000 /mm3
* Preoperative serum creatinine \>1.1 mg/dL
Minimum Eligible Age

19 Years

Maximum Eligible Age

40 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Mansoura University

OTHER

Sponsor Role lead

Responsible Party

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Mohamed Mohamed Tawfik

Lecturer, Department of anesthesia and surgical intensive care, Primary investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed M Tawfik, MD

Role: PRINCIPAL_INVESTIGATOR

Mansoura University Hospital

Locations

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Department of Anesthesia, Mansoura University Hospitals

Al Mansurah, Dakahlia Governorate, Egypt

Site Status

Countries

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Egypt

Other Identifiers

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R/17.06.79

Identifier Type: -

Identifier Source: org_study_id

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