Multimodal Uterotonics at the Time of Cesarean Section in Laboring Patients
Status:
Completed
Trial end date:
2021-02-15
Target enrollment:
Participant gender:
Summary
Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide,
even in high income countries. Uterine atony is estimated to cause 70-80% of postpartum
hemorrhage. Prolonged labor and augmented labor are known risk factors for postpartum
hemorrhage. In attempts to reduce the incidence of postpartum hemorrhage, particularly in
patients with known risks factors, it is essential to optimize preventative practices in
order to reduce the rates postpartum hemorrhage.
Although oxytocin is considered the first line therapy for preventing and treating uterine
atony, early consideration of additional prophylactic uterotonic agents may be indicated in
women with prior oxytocin exposure given oxytocin receptor desensitization and down
regulation.
As such, investigators sought to examine whether multimodal prophylactic uterotonics
(standard oxytocin + methylergonovine), in patients who are increased risk of developing
postpartum hemorrhage (specifically laboring patients who ultimately require a cesarean
section) would benefit from the addition of prophylactic uterotonics. The clinical rational
for administration of multimodal prophylactic uterotonics at the time of cesarean delivery in
laboring patients is three-fold: to decrease the incidence of uterine atony, to decrease the
incidence of postpartum hemorrhage, decrease the number of uterotonics required at the time
of cesarean section.
The primary outcome will be to evaluate the need for additional uterotonic agents
(Methylergonovine, Carboprost, Misoprostol) at the time of delivery.
Secondary outcomes will include the incidence of postpartum hemorrhage (quantitative blood
loss >1 liter), surgical assessment of uterine tone four minutes following delivery of the
placenta, preoperative and postoperative hemoglobin, the need for a blood transfusion,
intensive care unit admission, uterine infection (endometritis).