The Association Between Fluid Administration, Oxytocin Administration, and Fetal Heart Rate Changes

Northwestern University

Status: Terminated

Conditions: Labor Pain; Pregnancy

Treatments: Drug: Group B Intravenous bolus bolus 1000 ml lactated ringers solution oxytocin decrease to 1/2 current rate; Drug: Group A Intravenous bolus of 1000 ml lactated ringers solution; Drug: Group D 125 mL/hr lactated ringers oxytocin decreased to 1/2 current rate; Drug: Group C 125 mL/hr of lactated ringers

Study type: Interventional

Funder types: Other

Identifiers

NCT00787176

0524-034

Details and patient eligibility

About

Fetal heart rate patterns are an important parameter in the diagnosis of non-reassuring fetal status. Combined-spinal epidural analgesia is a method of initiating labor analgesia used by approximately 90% of the parturients at Prentice Women's Hospital. Optimizing the variables which could affect fetal heart rate patterns at the time of initiation of analgesia, such as fluid administration and oxytocin management, could help us provide better care for our patients and their fetuses.

Hypotheses: The combination of fluid administration and lower doses of oxytocin administration will have fewer adverse fetal heart rate changes in the first 60 minutes following initiation of labor analgesia.

Full description

After obtaining informed, written consent, candidates were randomized to one of four groups at the time of request for labor analgesia. All subjects received a maintenance infusion of Lactated Ringers(LR). For candidates in Groups A or B, an intravenous bolus of 1000 mL of LR was initiated. Candidates in Groups C and D did not receive any additional fluid. If randomized to group A or C, the oxytocin management was continued as per the normal active management of labor protocal (AMOL). If randomized to groups B or D, the dose of oxytocin that was being administered was halved and not increased until 60 minutes after the initiation of epidural analgesia. Fetal heart rate monitoring and frequency of uterine contractions were recorded by external tocodynamometry.

Enrollment: 251 patients

Sex: Female

Ages: 18 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Age 18-60
• Healthy nulliparous or multiparous women
• Term (>36 week gestation)
• Singleton pregnancy
• Spontaneous labor or with spontaneous rupture of membranes
• Receive oxytocin
• Request neuraxial analgesia

Exclusion criteria

• Under 18 years of age
• Presence of any systemic disease (e.g., diabetes mellitus, hypertension, preeclampsia)
• Use of chronic analgesic medications
• Prior administration of systemic opioid labor analgesia
• Non-vertex presentation
• Induction of labor
• Contraindication to neuraxial analgesia.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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251 participants in 4 patient groups

Group A

Active Comparator group

Description:

An intravenous bolus of 1000 mL Lactated Ringers initiated when the patient is positioned for epidural placement. Oxytocin management continued as per protocol.

Treatment:

Drug: Group A Intravenous bolus of 1000 ml lactated ringers solution

Group B

Experimental group

Description:

An intravenous bolus of 1000 mL Lactated Ringers. The dose of oxytocin being administered at time of epidural placement will be halved and not increased for 60 minutes until after placement.

Treatment:

Drug: Group B Intravenous bolus bolus 1000 ml lactated ringers solution oxytocin decrease to 1/2 current rate

Group C

Active Comparator group

Description:

The maintenance infusion of 125 mL/hr of Lactated Ringers will be given with no additional fluid bolus. Oxytocin management continued per protocol.

Treatment:

Drug: Group C 125 mL/hr of lactated ringers

Group D

Experimental group

Description:

The maintenance infusion of 125 mL/hr of Lactated Ringers will be given with no additional fluid bolus. The dose of oxytocin being administered at time of epidural placement was halved and not increased for 60 minutes until after placement.

Treatment:

Drug: Group D 125 mL/hr lactated ringers oxytocin decreased to 1/2 current rate