A Double-blind Randomized Placebo-controlled Four-arm Trial to Assess the Efficacy of Oral Bicarbonate and Intravenous Butylscopolamine Bromide to Facilitate Spontaneous (Non-operative) Delivery in Pregnant Female Participants With Induction of Labor
试验速览
- 阶段
- 3 期
- 状态
- 招募中
- 发起方
- 入组人数
- 3,000
- 试验地点
- 5
- 主要终点
- Spontaneous vs operative birth
研究概览
简要总结
Over the past years, the rates of labor induction have increased steadily, and at present more than one in four births occurs after induced labor in Norway. There is evidence that several groups of women benefit from labor induction, including those with preeclampsia (1), postdate pregnancy, diabetes, a large-for-gestational-age fetus, gestational diabetes, prelabor rupture of membranes at term, preterm prelabor rupture of membranes, twin pregnancy and intrahepatic cholestasis of pregnancy.
At the same time, induction of labor is an independent risk factor for adverse obstetric outcomes, including cesarean section, operative vaginal delivery, chorioamnionitis, labor dystocia, prolonged labor, uterine rupture, and neonatal pH < 7.10. A recent Norwegian nationwide clinical practice pilot evaluation demonstrated that the rate of intervention was high, and that as many as 44% of women with labor induction experienced operative delivery.
Given that induction of labor is a common procedure (15 000 women per year in Norway) and increases risk of several major obstetric complications, interventions that may reduce operative births and facilitate safe deliveries are highly warranted.
Bicarbonate and butylscopolamine bromide have been used in smaller studies in order to shorten labor. The medications seem to be safe with a low frequency of adverse events.
The rationale of the present study is therefore to assess the efficacy of oral bicarbonate and intravenous butylscopolamine bromide on facilitating spontaneous (non-operative) delivery in pregnant female participants with induction of labor.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 50 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Participant must be between 18 and 50 years of age at the time of signing the informed consent.
- •Participants who are female, pregnant, nulliparous and at or above 37 weeks of gestation
- •Participants who fulfill hospital criteria for induction of labor, and where a decision to induce labor has been made
- •Participants carrying a fetus in vertex position
- •Capable of giving signed informed consent as described in Appendix 1, which includes compliance with the requirements and restrictions listed in the informed consent form (ICF).
排除标准
- •Multiple gestation
- •Elective cesarean section
- •Spontaneous start of labor
- •Known maternal intestinal stenosis, ileus or megacolon
- •Persisting maternal tachycardia (heart rate > 130 beats per minute) >30 minutes continuously.
- •Known maternal myasthenia gravis
- •Persisting fetal tachycardia (fetal heart rate baseline > 170 beats per minute) >30 minutes continuously.
- •Maternal hypersensitivity to any of the ingredients in IMP (butylscopolamine bromide, bicarbonate or sodium chloride)
- •Women with heart disease who are under surveillance with heart rate monitoring during labor
- •Known fetal heart disease or known fetal malformations in the gastrointestinal system
- •Untreated maternal glaucoma
- •Maternal electrolyte disturbance: severe hyponatremia, severe hypokalemia
- •Maternal moderate/severe kidney failure (stage III-V: glomerulus filtration rate <59 ml/minute/1.73m2 )
- •Maternal elevated serum creatinine (>90umol/L)
- •Maternal elevated Alanine Aminotransferase (ALAT) >100 U/L. Participation can still be considered for participants with ALAT >100 U/L if explained by obstetric cholestasis or HELLP syndrome.
研究组 & 干预措施
Buscopan and bicarbonate
干预措施: Buscopan 20 MG/ML Injectable Solution (Drug)
Buscopan and bicarbonate
干预措施: Sodium bicarbonate (Drug)
Buscopan and placebo
干预措施: Buscopan 20 MG/ML Injectable Solution (Drug)
Buscopan and placebo
干预措施: Placebo (Drug)
Placebo and bicarbonate
干预措施: Sodium bicarbonate (Drug)
Placebo and bicarbonate
干预措施: Nacl 0.9% (Drug)
Placebo and placebo
干预措施: Placebo (Drug)
Placebo and placebo
干预措施: Nacl 0.9% (Drug)
结局指标
主要结局
Spontaneous vs operative birth
时间窗: Through study completion, an average of one week
Number of participants with operative birth as compared to spontaneous birth
次要结局
未报告次要终点
研究者
Trond Melbye Michelsen
Professor, Senior Consultant
Oslo University Hospital