Assessing Effects of Lateral Tilt on Cardiac Output Using a Non-invasive Technique

NCT ID: NCT04112719

Last Updated: 2020-10-26

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

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-11-01

Study Completion Date

2020-04-01

Brief Summary

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In pregnant term patients, we intent to use a non invasive cardiac output monitor to detect the changes in cardiac output as the patient is being placed in different positions.

The patient will be placed on her back, flat, and in left lateral tilt at two different angles. Measurements of cardiac output will be recorded.

Detailed Description

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Aortocaval compression compromising tissue perfusion has always been of a concern in term pregnant women undergoing caesarian delivery or regional anesthesia when placed in the supine position. It is believed that this phenomena happens when the gravid uterus compresses the inferior vena cava (IVC)resulting in decreased venous return and hence cardiac output (CO) leading to low placental perfusion and associated fetal heart rate changes.

Hence, due to these concerns, left lateral tilt is currently a common practice in obstetrics and it is believed to relief aortocaval compression and to improve blood flow to the fetus.

Supporting evidence for this intervention remains controversial, and shows conflicting results. Some studies suggest that lateral tilt does not affect neonatal outcomes (1) or changes in cardiac output in patients with no regional anesthesia (2). While others suggest it can actually increase the volume of the IVC, especially when the patient is tilted 30 degrees or more (3) and may lead to increases in CO (4).

Non-invasive hemodynamic monitoring (NICOM, Cheetah Medical), an FDA approved device, is currently being used to detect changes in CO in the United States. Its use has been validated in different clinical settings (5,6).

Our hypothesis is that CO is increased in pregnant women that were placed in the lateral tilt position.

We intend to compare CO measurements using the non-invasive hemodynamic monitoring among term pregnant patients in supine vs lateral tilt position.

Conditions

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Cardiac Output

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Control arm/pregnant patients at term

Control arm where the term pregnant patient will be lying on the bed at 45 degrees.

No interventions assigned to this group

Experimental/Supine

Term pregnant patient will be positioned in supine. Changes in hemodynamics will be measured.

supine position

Intervention Type OTHER

The patient will be placed in a supine position. Changes in cardiac output will be measured.

Experimental/15 degrees lateral tilt

Term pregnant patient will be positioned at 15 degrees in lateral tilt. Changes in hemodynamics will be measured.

15 degrees lateral tilt

Intervention Type OTHER

The patient will be placed in 15 degrees lateral tilt position. Changes in cardiac output will be measured.

Experimental/30 degrees lateral tilt

Term pregnant patient will be positioned at 30 degrees in lateral tilt. Changes in hemodynamics will be measured.

30 degrees lateral tilt

Intervention Type OTHER

The patient will be placed in 30 degrees lateral tilt position. Changes in cardiac output will be measured.

Interventions

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supine position

The patient will be placed in a supine position. Changes in cardiac output will be measured.

Intervention Type OTHER

15 degrees lateral tilt

The patient will be placed in 15 degrees lateral tilt position. Changes in cardiac output will be measured.

Intervention Type OTHER

30 degrees lateral tilt

The patient will be placed in 30 degrees lateral tilt position. Changes in cardiac output will be measured.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Pregnant women between the ages of 18-50.
* Elective repeat cesarean section or induction of labor.

Exclusion Criteria

* Incarcerated patients
* Patient unwilling or unable to provide consent
* Intrauterine fetal demise (no fetal heart beat identified and documented by two physicians).
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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The University of Texas Medical Branch, Galveston

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Antonio Saad, MD

Role: STUDY_DIRECTOR

UTMB

Locations

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UTMB

Galveston, Texas, United States

Site Status

Countries

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United States

Other Identifiers

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19-0086

Identifier Type: -

Identifier Source: org_study_id