In Vitro Evaluation of Spontaneous and Oxytocin-induced Contractility of Pregnant Human Myometrium During Exposure to Dexmedetomidine

Sponsor

Samuel Lunenfeld Research Institute, Mount Sinai Hospital (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT05511415

Collaborator

(none)

Enrollment

Location

Arms

Anticipated Duration (Months)

3.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Postpartum hemorrhage (PPH) remains to be one of the leading causes of maternal morbidity and mortality. It has been noted that an increasing number of PPH is attributed to the increased incidence of uterine atony. Myometrial contraction is affected by the choice of anesthetic technique and medications during cesarean delivery (CD). It has been proven that exposure to oxytocin during labor results in a decrease in myometrial contractions.

Dexmedetomidine is a drug which has been used in obstetric practice due to its desirable effects such as decreasing pain, reduced elevation in blood pressure and heart rate, sedation, and diminished anesthetic requirement. It has been used as an adjunct during spinal or epidural anesthesia during CD and even during general anesthesia for some obstetric surgeries.

The use of dexmedetomidine has been continuously rising due to its favorable effects. Its use as an adjunct in general anesthesia for obstetrical surgeries has been shown to have promising advantages. During this pandemic, dexmedetomidine has been utilized largely as a sedative in critically ill and intubated patients. This does not exclude critically ill pregnant patients who may also need to deliver urgently. Thus, it is important to investigate its effect on uterine contractility on this particular group of patients.

The investigators hypothesize that dexmedetomidine causes a dose-dependent increase in contractility of the pregnant human myometrium, both spontaneous and oxytocin-induced.

Condition or Disease	Intervention/Treatment	Phase
Postpartum Hemorrhage	Drug: Oxytocin Drug: Dexmedetomidine	N/A

Study Design

Study Type:

Interventional

Anticipated Enrollment :

28 participants

Allocation:

Non-Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

In Vitro Evaluation of Spontaneous and Oxytocin-induced Contractility of Pregnant Human Myometrium During Exposure to Dexmedetomidine

Anticipated Study Start Date :

Sep 1, 2022

Anticipated Primary Completion Date :

Jun 1, 2023

Anticipated Study Completion Date :

Jun 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Dexmedetomidine The myometrial samples are bathed in increasing concentrations of dexmedetomidine (from 10 -9M to 10 -4M).	Drug: Dexmedetomidine Dexmedetomidine (10-9M to 10-4M)
Active Comparator: Oxytocin The myometrial samples are bathed in oxytocin 20nM.	Drug: Oxytocin Oxytocin solution, 20nM concentration Other Names: pitocin
Active Comparator: Dexmedetomidine + Oxytocin The myometrial samples are bathed in oxytocin at 20nM along with dexmedetomidine (10-9M to 10-4M).	Drug: Oxytocin Oxytocin solution, 20nM concentration Other Names: pitocin Drug: Dexmedetomidine Dexmedetomidine (10-9M to 10-4M)
Active Comparator: Oxytocin pre-treatment followed by Dexmedetomidine The myometrial samples are pre-treated with oxytocin (10-5M) for 2 hours, and then in increasing concentrations of dexmedetomidine (from 10 -9M to 10 -4M).	Drug: Oxytocin Oxytocin solution, 20nM concentration Other Names: pitocin Drug: Dexmedetomidine Dexmedetomidine (10-9M to 10-4M)
Active Comparator: Oxytocin pre-treatment followed by Oxytocin The myometrial samples are pre-treated with oxytocin (10-5M) for 2 hours, and then bathed in oxytocin at 20nM.	Drug: Oxytocin Oxytocin solution, 20nM concentration Other Names: pitocin
Active Comparator: Oxytocin pre-treatment followed by Dexmedetomidine + Oxytocin The myometrial samples are pre-treated with oxytocin (10-5M) for 2 hours, and then bathed in oxytocin at 20nM along with dexmedetomidine (10-9M to 10-4M)	Drug: Oxytocin Oxytocin solution, 20nM concentration Other Names: pitocin Drug: Dexmedetomidine Dexmedetomidine (10-9M to 10-4M)

Outcome Measures

Primary Outcome Measures

Motility index [4 hours]
Motility index (MI) is a calculated outcome, based on the formula: frequency/(10 x amplitude). Frequency and amplitude are secondary outcome measures as described below. The analysis is undertaken by attaching myometrial strips between an isometric force transducer and the base of an organ bath chamber.

Secondary Outcome Measures

Amplitude of contraction [4 hours]
The maximum extent of uterine muscle contraction, measured in grams (g). The analysis is undertaken by attaching myometrial strips between an isometric force transducer and the base of an organ bath chamber.
Frequency of contraction [4 hours]
The number of contractions in uterine muscle (myometrium) over 10 minutes, spontaneously and in response to an agonist. The analysis is undertaken by attaching myometrial strips between an isometric force transducer and the base of an organ bath chamber.
Integrated area under response curve (AUC) [4 hours]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 50 Years

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

Pregnant patients scheduled for elective CD under regional anesthesia at 37-41 weeks of gestational age will be included in this study.
Only patients for primary CD or repeat CD (1x) will be included in this study since excessive uterine scarring from multiple CD may affect the contractility of myometrial sample.

Exclusion Criteria:

patient refusal
emergency CD
general anesthesia
placenta accreta spectrum disorder
any condition predisposing the patient to uterine atony (e.g. polyhydramnios, multiple gestation)
patients taking medications affecting myometrial contractions(labetalol, magnesium etc.).