Postpartum HemorrhageNCT02051231
Recovery of Oxytocin Responsiveness in Pregnant Human Myometrial Explants After Oxytocin-Induced Desensitization
A study testing Oxytocin in people with Postpartum Hemorrhage, run by Samuel Lunenfeld Research Institute, Mount Sinai Hospital at 1 site in Canada.
Trial summary
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide and is caused most commonly by poor uterine muscle tone after delivery. The first line agent used in the prevention and treatment of PPH is oxytocin, which acts by binding with oxytocin receptors (OTR) found on myometrial… Read more about this study
- Who is it for?
- Ages 18 to 55 years, women onlyHealthy volunteers can take part
- Conditions the study is for
- Postpartum Hemorrhage
- What is being tested?
- Oxytocin
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 22 participants
- Where
- 1 siteCanada
- Study dates
- Dec 2013to Jun 2014
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 55 years
- Women only
- Healthy volunteers accepted
- Adult
Who may be able to join
- Patients who give written consent to participate in this study
- Patients with gestational age 37-41 weeks
- Non-laboring patients, not exposed to exogenous oxytocin
- Patients requiring primary Cesarean section or first repeat Cesarean section
Who cannot join
- Patients who refuse to give written informed consent
- Patients who require general anesthesia
- Patients who had previous uterine surgery or more than one previous Cesarean section
- Patients with a multiple pregnancy (more than one fetus)
- Patients with any condition predisposing to uterine atony and postpartum hemorrhage, such as abnormal placentation, multiple gestation, preeclampsia, macrosomia, polyhydramnios, uterine fibroids, bleeding diathesis, chorioamnionitis, or a previous history of postpartum bleeding
- Emergency Cesarean section in labor
- Patients with bleeding disorders
Trial locations and contacts
1 site in 1 country.
About this study
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide and is caused most commonly by poor uterine muscle tone after delivery. The first line agent used in the prevention and treatment of PPH is oxytocin, which acts by binding with oxytocin receptors (OTR) found on myometrial cells to cause uterine contraction.
Women who require augmentation of labour with oxytocin because of inadequate labour progression are at increased risk of PPH because they have received intravenous oxytocin which exposes the uterus (and OTR) to doses greater than would normally be found without medical intervention. This exposure results in OTR desensitization and decreased uterine sensitivity to oxytocin which may lead to the use of much higher doses of oxytocin (up to 9x) or other agents for preventing and treating PPH with the potential for causing serious drug-related morbidity or fatality to the mother.
Read more
Currently, in women who have failed labour augmentation and need to have a Cesarean delivery, it is not known if it would be beneficial to wait a certain period of time after discontinuing intravenous oxytocin before proceeding with the operation. The goal of the waiting time would be to allow the OTRs to recover and resensitize the uterus to the effects of oxytocin to avoid the need for high doses or additional uterus-contracting agents.
Our hypothesis is that there will be a positive correlation between the magnitude of recovery of the myometrium's response to oxytocin and the time elapsed from the desensitizing oxytocin pretreatment (simulated labour augmentation).
Read the detailed description
The investigators have previously established an in vitro model of labour augmentation and myometrial desensitization using pregnant human myometrium and an isometric tension recording device. The investigators propose to use this model in order to characterize the time course of recovery of oxytocin-desensitized myometrium to oxytocin sensitivity. These results will help in establishing whether myometrial recovery can occur within a clinically relevant time period, how much sensitivity is recovered, and the duration required.
In the clinical setting of failed labour augmentation and OTR desensitization, it is not known if it is beneficial to wait a certain period of time after discontinuing intravenous oxytocin before proceeding to Cesarean section to allow for resensitization of the myometrium to oxytocin. The results of this study will provide insight into the time course of recovery of the myometrium using an in vitro model of failed labour augmentation. Based on the oxytocin dose-response curves after variable periods of time of "rest", the investigators will be able to determine the degree of recovery of myometrial contractility over time and whether this will occur in a clinically relevant time period for implementation into clinical practice.
- Conditions
- Postpartum Hemorrhage
- Being tested
- Oxytocin
- Keywords
- Uterine contraction, Oxytocin receptors, Oxytocin desensitization
- Medical subject headings
- Postpartum Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
OxytocinDrug
Also called Pitocin
Oxytocin, 10-10mol/L to 10-5mol/L
| Study group | Role | What they receive |
|---|---|---|
| Control | No intervention | A control sample from each patient (no oxytocin applied) will be measured concurrently with samples treated with oxytocin. |
| Oxytocin | Experimental | Samples from each patient will be exposed to oxytocin and then allowed to rest for 30, 60 or 90 minutes. Receives: Drug: Oxytocin |
What is being measured
The primary outcome is the main question the study is designed to answer.
Amplitude of contraction
Measured: 2-4 hours
Secondary outcomes (3)
frequency of contraction
Measured: 2-4 hours
Integrated area under response curve (AUC)
Measured: 2-4 hours
basal tone
Measured: 2-4 hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted31 Jan 2014 (estimated)
- Study startDec 2013
- Primary completionJun 2014
- Study completionJun 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Postpartum HemorrhageStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 22 participants (actual)
Sponsor and investigators
- Lead sponsor
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Mrinalini Balki, MD, Principal investigator, MOUNT SINAI HOSPITAL
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02051231
- Sponsor's protocol ID
- 14-01
- Status last verified
- May 2015
- First submitted
- 29 Jan 2014
- Last updated
- 27 May 2015
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 27 May 2015. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Recovery of Oxytocin Responsiveness in Pregnant Human Myometrial Explants After Oxytocin-Induced Desensitization
- ClinicalTrials.gov ID
- NCT02051231
- Acronym / sponsor ID
- 14-01
- Conditions
- Postpartum Hemorrhage
- Keywords
- Uterine contraction, Oxytocin receptors, Oxytocin desensitization
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 22 participants (actual)
- Lead sponsor
- Samuel Lunenfeld Research Institute, Mount Sinai HospitalUniversity, hospital or other
- Study start
- Dec 2013
- Primary completion
- Jun 2014 (actual)
- Study completion
- Jun 2014 (actual)
- First posted
- 31 Jan 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide and is caused most commonly by poor uterine muscle tone after delivery. The first line agent used in the prevention and treatment of PPH is oxytocin, which acts by binding with oxytocin receptors (OTR) found on myometrial cells to cause uterine contraction.
Women who require augmentation of labour with oxytocin because of inadequate labour progression are at increased risk of PPH because they have received intravenous oxytocin which exposes the uterus (and OTR) to doses greater than would normally be found without medical intervention. This exposure results in OTR desensitization and decreased uterine sensitivity to oxytocin which may lead to the use of much higher doses of oxytocin (up to 9x) or other agents for preventing and treating PPH with the potential for causing serious drug-related morbidity or fatality to the mother.
Currently, in women who have failed labour augmentation and need to have a Cesarean delivery, it is not known if it would be beneficial to wait a certain period of time after discontinuing intravenous oxytocin before proceeding with the operation. The goal of the waiting time would be to allow the OTRs to recover and resensitize the uterus to the effects of oxytocin to avoid the need for high doses or additional uterus-contracting agents.
Our hypothesis is that there will be a positive correlation between the magnitude of recovery of the myometrium's response to oxytocin and the time elapsed from the desensitizing oxytocin pretreatment (simulated labour augmentation).
Detailed description
The investigators have previously established an in vitro model of labour augmentation and myometrial desensitization using pregnant human myometrium and an isometric tension recording device. The investigators propose to use this model in order to characterize the time course of recovery of oxytocin-desensitized myometrium to oxytocin sensitivity. These results will help in establishing whether myometrial recovery can occur within a clinically relevant time period, how much sensitivity is recovered, and the duration required.
In the clinical setting of failed labour augmentation and OTR desensitization, it is not known if it is beneficial to wait a certain period of time after discontinuing intravenous oxytocin before proceeding to Cesarean section to allow for resensitization of the myometrium to oxytocin. The results of this study will provide insight into the time course of recovery of the myometrium using an in vitro model of failed labour augmentation. Based on the oxytocin dose-response curves after variable periods of time of "rest", the investigators will be able to determine the degree of recovery of myometrial contractility over time and whether this will occur in a clinically relevant time period for implementation into clinical practice.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Control | No intervention | –A control sample from each patient (no oxytocin applied) will be measured concurrently with samples treated with oxytocin. |
| Oxytocin | Experimental | Drug: OxytocinSamples from each patient will be exposed to oxytocin and then allowed to rest for 30, 60 or 90 minutes. |
Who may qualify
- Ages
- 18 to 55 years
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (4 listed)
- Patients who give written consent to participate in this study
- Patients with gestational age 37-41 weeks
- Non-laboring patients, not exposed to exogenous oxytocin
- Patients requiring primary Cesarean section or first repeat Cesarean section
Key exclusion criteria (7 listed)
- Patients who refuse to give written informed consent
- Patients who require general anesthesia
- Patients who had previous uterine surgery or more than one previous Cesarean section
- Patients with a multiple pregnancy (more than one fetus)
- Patients with any condition predisposing to uterine atony and postpartum hemorrhage, such as abnormal placentation, multiple gestation, preeclampsia, macrosomia, polyhydramnios, uterine fibroids, bleeding diathesis, chorioamnionitis, or a previous history of postpartum bleeding
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| OxytocinAlso: PitocinOxytocin, 10-10mol/L to 10-5mol/L | Drug | Oxytocin |
Primary outcome
Amplitude of contraction
Time frame: 2-4 hours
3 secondary outcomes
frequency of contraction
Time frame: 2-4 hours
Integrated area under response curve (AUC)
Time frame: 2-4 hours
basal tone
Time frame: 2-4 hours
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 May 2015.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mrinalini Balki, MD principal investigator
MOUNT SINAI HOSPITAL
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Oxytocin in people with Postpartum Hemorrhage, run by Samuel Lunenfeld Research Institute, Mount Sinai Hospital at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 27 May 2015. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Amplitude of contraction (time frame: 2-4 hours). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 May 2015.