Clinical Trial: Antepartum Chronic Epidural Therapy (ACET) to Improve Blood Flow to the Uterus, Placenta and Baby in Pre-Eclampsia and Intrauterine Growth Restriction

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Antepartum Chronic Epidural Therapy (ACET) Using Ropivacaine to Improve Uteroplacental Blood Flow in Pre-Eclampsia and Intrauterine Growth Restriction

Brief Summary: Pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are common and important disorders of pregnancy. Both disorders are associated with an impairment of uteroplacental blood flow (UPBF). No effective therapy has been identified to reliably improve UPBF in these patients and typically, obstetric management involves interventional delivery, particularly problematic when remote from term. This study assess the hypothesis that epidural local anesthetics may improve UPBF in these patients.

Detailed Summary: Women with sonographic uterine artery flow abnormalities and either PE or IUGR (or both) were randomized to either ACET or non ACET control. Both groups were able to receive standard therapies (in-hospital monitoring, magnesium and anti-hypertensives as appropriate). The first five days of the therapeutic arm (ACET) consisted of a dose-finding trial, where epidural ropivacaine infusions (10ml/hr for 24 hours) of 0•04%, 0•06%, 0•08% and 0•1% and a saline placebo were each administered via tunneled epidural catheters in a randomized, double-blinded, cross-over design over five consecutive days; all three women received all doses. Doppler measurement of flow in the uterine artery was performed at baseline and at the end of each dose period. The ideal dose for an individual was determined to be lowest dose of drug giving maximal effect without side effects; in the second stage of the study, this dose was administered until delivery with the addition of a second placebo day to during this period.
Sponsor: Hadassah Medical Organization

Current Primary Outcome:

  • Uterine artery blood flow
  • Gestational age at delivery.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Ductus venosus and MCA blood flow
  • Proprioceptive loss;
  • Maternal hemodynamic changes;
  • Fetal weight (throughout pregnancy and at delivery); amniotic fluid index;
  • obstetric outcome (maternal mortality, morbidity, neonatal mortality, morbidity, mode of delivery, obstetric complications).


Original Secondary Outcome: Same as current

Information By: Hadassah Medical Organization

Dates:
Date Received: September 13, 2005
Date Started: August 2003
Date Completion:
Last Updated: July 14, 2008
Last Verified: February 2006