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Postpartum HemorrhagePhase 4INBOX-HRNCT07688512

Oxytocin Bolus Versus Infusion in High-Risk Patients Undergoing Elective Cesarean Section (INBOX-HR)

A Phase 4 study testing Oxytocin Bolus or Oxytocin Infusion in people with Postpartum Hemorrhage and Uterine Atony, run by Stony Brook University.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

The goal of this randomized, double-blind clinical trial is to learn if Oxytocin is most effective at achieving adequate uterine tone (important for preventing postpartum hemorrhage) when administered as a bolus or an infusion in patients at high-risk for postpartum hemorrhage in elective cesarean sections. Read more about this study

Who is it for?
Ages 18 to 45 years, women only
What is being tested?
Oxytocin Bolus or Oxytocin Infusion
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
180 participants
Where
No sites listed yet
Study dates
Aug 2026to Feb 2029
Phase
Phase 4
Are there results?
Not yet: the study is under way

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 45 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Undergoing elective cesarean section under spinal anesthesia or combined spinal anesthesia (CSE)
  • Patients must be able to provide written informed consent in either English or Spanish
  • Parturient classified as high risk for postpartum hemorrhage as defined by the adapted California Maternal Quality Care Obstetric Hemorrhage Risk Screen

Who cannot join

  • Parturient in labor or ruptured membranes
  • Patient does not possess the physical and mental capacity to provide informed consent
  • Urgent or emergent cesarean sections
  • Patients with a known major coagulopathy
  • Patients with significant thrombocytopenia limiting neuraxial anesthesia (<70k)
  • Patients on therapeutic anticoagulation at time of procedure
Show all 9Show fewer
  • Patients on the placenta accreta spectrum
  • Patients with severe cardiac disease contraindicating oxytocin
  • Patients with an allergy to oxytocin

Trial locations and contacts

No sites are listed yet. Contact the study team or a site near you to ask about taking part.

About this study

Official title: Randomized Double-Blinded Clinical Trial of Oxytocin Bolus Versus Infusion in High-Risk Patients Undergoing Elective Cesarean Section

The goal of this randomized, double-blind clinical trial is to learn if Oxytocin is most effective at achieving adequate uterine tone (important for preventing postpartum hemorrhage) when administered as a bolus or an infusion in patients at high-risk for postpartum hemorrhage in elective cesarean sections. The main questions that will be answered are:

  1. Is Oxytocin bolus more effective than Oxytocin infusion at achieving adequate uterine tone at 2 minutes after the baby is born and every minute thereafter?
  2. Does Oxytocin bolus cause less maternal side effects than Oxytocin infusion?
  3. Does Oxytocin bolus result in less blood loss than Oxytocin infusion in high risk for postpartum hemorrhage patients undergoing elective cesarean sections?
  4. Are patients more satisfied with their cesarean section when they receive Oxytocin bolus or Oxytocin infusion?
Read more

Researchers will compare the 2 methods of Oxytocin administration, bolus versus infusion, to see which method is more effective or if they are equally effective.

Participants will:

  1. Be randomized to receive either Oxytocin bolus or Oxytocin infusion during their cesarean section but after the baby is born.
  2. Be asked a question about their experience 2 hours after the surgery.
  3. Allow the research team to collect information about how they are doing from their hospital medical records.
Read the detailed description

Oxytocin is the most commonly used uterotonic agent worldwide to achieve adequate uterine tone and prevent postpartum hemorrhage. Over the past decade, the trend has been towards lowering the dose to reduce oxytocin-related adverse effects including nausea, hypotension, chest pain, EKG changes, and maternal death. However, the optimal strategy for oxytocin administration remains controversial. A prior study was conducted at Stony Brook University Hospital which investigated the difference between bolus versus infusion administration of oxytocin in elective cesarean section patients with a low risk of postpartum hemorrhage (PPH); the results of this randomized, double blinded clinical trial showed that bolus was not superior for adequate uterine tone at 2 minutes when compared to infusion of oxytocin, but blood loss was modestly lower and total oxytocin exposure was substantially lower in the bolus arm. Which makes the most logical next question: Does bolus oxytocin become more clinically meaningful in patients with higher baseline risk for uterine atony or hemorrhage. The investigators aim to address this question with the INBOX-HR study.

INBOX-HR acts as a continuing investigation on the difference between bolus versus infusion administration of oxytocin, specifically for patients that are at a high risk for postpartum hemorrhage. Thus, the purpose of this research study is to compare bolus and infusion administration of oxytocin on parturients at high risk for postpartum hemorrhage undergoing elective cesarean section. The primary objective of this study is to test the hypothesis that administration by bolus vs. infusion results in more rapid achievement of adequate uterine tone in this patient population. Secondary objectives include determining estimated blood loss, prevalence of hypotension, change in heart rate, nausea, vomiting, and patient satisfaction, and 0 - 10 uterine tone score.

Being tested
Oxytocin Bolus or Oxytocin Infusion
Keywords
Oxytocin bolus vs infusion in elective cesarean section in patients at high risk for postpartum hemorrhage
Medical subject headings
Postpartum Hemorrhage, Uterine Inertia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Oxytocin Bolus or Oxytocin InfusionDrug

    On the day of surgery, patients will be randomized to receive either bolus or infusion administration of Oxytocin.

    On the day of the procedure, periprocedural data and patient satisfaction (single question) will be recorded.

Study groups in NCT07688512
Study groupRoleWhat they receive
Oxytocin BolusActive comparatorPatients in the bolus arm will receive a 3 IU oxytocin IV bolus over 15 seconds after delivery of the baby/uterine cord clamping and a maintenance infusion of 0.9% Saline will be started at 225ml/hr. If uterine tone is considered inadequate after an additional 3 minutes, a second bolus of 3 IU oxytocin is given IV over 15 seconds. If uterine tone is inadequate after an additional 3 minutes, a third bolus of 3 IU Oxytocin IV is given over 15 seconds. If after an additional 3 mins uterine tone is still inadequate, a second infusion consisting of oxytocin 3 IU/hr is started at 100ml/hrs and continued for a total of 4 hours, second line uterotonic agents (Methergine, Hemabate and/ or Cytotec) will be given, and the maintenance 0.9% Saline infusion will be changed to 450 ml/hr for a total of 1 hour, then changed to 38 ml/ hour for the following 3 hours. If uterine tone is considered adequate at 3, 6 or 9 minutes, a second infusion of oxytocin 3 IU/hr (100ml/hr) is started and maintained
Receives: Drug: Oxytocin Bolus or Oxytocin Infusion
Oxytocin InfusionActive comparatorPatients in the infusion arm will receive a bolus of IV 0.9% Saline over 15 seconds after delivery of the baby/uterine cord clamping and a maintenance infusion of 18 IU/hr Oxytocin IV (225ml/hr). If uterine tone is considered inadequate after an additional 3 minutes, a second bolus of 0.9% Saline will be given IV over 15 seconds. If uterine tone is inadequate after an additional 3 minutes, a third bolus of 0.9% Saline will be given IV over 15 seconds. If after an additional 3 mins uterine tone is still inadequate, a second infusion of 0.9% Saline will be started at 100 ml/hr for 4 hours, second line uterotonic agents (Methergine, Hemabate and/or Cytotec) will be given, and the Oxytocin infusion will be changed to 36 IU/hour (450 ml/hr) for a total of 1 hour, and then changed to 38 ml/hr for the following 3 hours. If uterine tone is considered adequate at 3, 6 or 9 minutes, a second infusion of 0.9% Saline at 100 ml/hr will be started and maintained for 4 hours.
Receives: Drug: Oxytocin Bolus or Oxytocin Infusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to uterine tone

    Uterine tone will be assessed at 2 mins and then every minute thereafter until adequate uterine tone is attained but no more than 10 minutes maximum, by a blinded obstetrician. Uterine tone will be deemed adequate or inadequate by the blinded obstetrician. The time for the primary endpoint analysis is adequacy of uterine tone at 2 minutes after the baby is born/umbilical cord clamped.

    Measured: 2 minutes after umbilical cord clamp until 10 minutes.

Secondary outcomes (8)
  1. Estimated intraoperative blood loss

    Measured: From the start to end of surgery

  2. Changes in heart rate (beats per minute)

    Measured: During uterine cord clamp and every 2 minutes thereafter until 10 minutes

  3. Changes in blood pressure (mmHg)

    Measured: During uterine cord clamp and every 2 minutes thereafter until 10 minutes.

  4. Total dose of phenylephrine administered intraoperatively

    Measured: From the start to end of surgery

  5. Participants with need for additional uterotonic agents

    Such as Methergine, Hemabate, and Cytotec

    Measured: From oxytocin administration until end of surgery

  6. 0-10 Uterine tone score

    Uterine tone score will be assessed at 2 mins and then every minute thereafter.

    Measured: 2 minutes after uterine cord clamping until 10 minutes.

  7. Participants with maternal side effects

    Chest pain, nausea, vomiting

    Measured: From oxytocin administration until end of surgery

  8. Patient satisfaction questionnaire

    The patient will be asked a question about their experience on a scale of 0-10 (0 being complete dissatisfaction, and 10 being highly satisfied).

    Measured: 2 hours after surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2026
  2. Study startAug 2026 (estimated)
  3. Primary completionAug 2028 (estimated)
  4. Study completionFeb 2029 (estimated)

Resources

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 4
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized, double-blinded, 2-arm, parallel study.
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
180 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07688512
Sponsor's protocol ID
IRB2026-00322
Acronym
INBOX-HR
Status last verified
Jun 2026
First submitted
24 Jun 2026
Last updated
3 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Wang LY, Wang J, Dong JH, Ping ZP, Chen XZ, Wei CN. The optimal oxytocin infusion rate for preventing uterine atony during cesarean delivery in elderly parturients with prior history of cesarean delivery. Front Pharmacol. 2023 Jul 28;14:1211693. doi: 10.3389/fphar.2023.1211693. eCollection 2023.

    PubMed 37576820
  • Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol. 2010 Mar;53(1):147-56. doi: 10.1097/GRF.0b013e3181cc406d.

    PubMed 20142652
  • Joseph J, George SK, Daniel M, Ranjan RV. A randomised double-blind trial of minimal bolus doses of oxytocin for elective caesarean section under spinal anaesthesia: Optimal or not? Indian J Anaesth. 2020 Nov;64(11):960-964. doi: 10.4103/ija.IJA_377_20. Epub 2020 Nov 1.

    PubMed 33487681
  • Fuchs AR, Fuchs F, Husslein P, Soloff MS. Oxytocin receptors in the human uterus during pregnancy and parturition. Am J Obstet Gynecol. 1984 Nov 15;150(6):734-41. doi: 10.1016/0002-9378(84)90677-x.

    PubMed 6093538
  • Terblanche N, Otahal P, Messmer A, Wright P, Patel S, Nathan K, Sharman JE. An observational cohort study of 3 units versus 5 units slow intravenous bolus oxytocin in women undergoing elective caesarean delivery. J Physiol Pharmacol. 2017 Aug;68(4):547-553.

    PubMed 29151071
  • Balki M, Tsen L. Oxytocin protocols for cesarean delivery. Int Anesthesiol Clin. 2014 Spring;52(2):48-66. doi: 10.1097/AIA.0000000000000016. No abstract available.

    PubMed 24667448
  • Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, Gulmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun;2(6):e323-33. doi: 10.1016/S2214-109X(14)70227-X. Epub 2014 May 5.

    PubMed 25103301

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Oxytocin Bolus or Oxytocin Infusion in people with Postpartum Hemorrhage and Uterine Atony, run by Stony Brook University.

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 3 inclusion and 9 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: opening soon, as of the sponsor's last update on 3 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Tiffany E Angelo, DO, FASA (631-759-0328, tiffany.angelo@stonybrookmedicine.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to uterine tone (time frame: 2 minutes after umbilical cord clamp until 10 minutes.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07688512, which also lists 7 linked publications.

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 3 Aug 2026.

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