Cargando…

Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial

BACKGROUND: Labour is perhaps the most hazardous time in pregnancy. As many as 20 % of cerebral palsy cases in term infants result from intrapartum events and up to 63 % of babies who develop intrapartum compromise have no prior risk factors. Sildenafil citrate (SC), a phosphodiesterase 5 inhibitor,...

Descripción completa

Detalles Bibliográficos
Autores principales: Dunn, Liam, Flenady, Vicki, Kumar, Sailesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712615/
https://www.ncbi.nlm.nih.gov/pubmed/26767411
http://dx.doi.org/10.1186/s12967-016-0769-0
_version_ 1782410100237926400
author Dunn, Liam
Flenady, Vicki
Kumar, Sailesh
author_facet Dunn, Liam
Flenady, Vicki
Kumar, Sailesh
author_sort Dunn, Liam
collection PubMed
description BACKGROUND: Labour is perhaps the most hazardous time in pregnancy. As many as 20 % of cerebral palsy cases in term infants result from intrapartum events and up to 63 % of babies who develop intrapartum compromise have no prior risk factors. Sildenafil citrate (SC), a phosphodiesterase 5 inhibitor, improves uterine blood supply through vasodilatation and potentially could improve placental perfusion and hence reduce the risk of intrapartum fetal hypoxia. The aim of this study is to evaluate the efficacy of SC to reduce the risk of intrapartum fetal compromise and the need for emergency operative delivery. METHODS/DESIGN: This is a single centre, double-blind, randomised, phase II clinical trial of SC or placebo given during labour to women (18–50 years of age) with a single, appropriately grown, non-anomalous baby at term (37–42 weeks gestation). Those with cardiovascular, renal, hepatic, ocular or hypertensive disease or contraindication to SC will be excluded. Participants will be randomised to either SC 50 mg or placebo capsules eight hourly (SC maximum 150 mg) to commence when admitted to birth suite for management of labour. Within 3 h of the first dose, a repeat ultrasound scan will be performed to measure any changes in uteroplacental and fetal Doppler indices. Labour will continue otherwise in accordance with hospital clinical guidelines. The primary outcome is emergency caesarean section for intrapartum fetal compromise. Secondary outcomes include the effect of SC on fetal and uteroplacental blood flow, meconium liquor, fetal heart rate abnormalities and neonatal outcomes (admission to neonatal intensive care, Apgar <7 at 5 min, cord pH <7.1 or lactate >4.0 mmol/L, neonatal encephalopathy, death). CONCLUSION: This is the first reported study evaluating the efficacy of SC on reducing the risk intrapartum fetal compromise. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615000319572
format Online
Article
Text
id pubmed-4712615
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-47126152016-01-15 Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial Dunn, Liam Flenady, Vicki Kumar, Sailesh J Transl Med Protocol BACKGROUND: Labour is perhaps the most hazardous time in pregnancy. As many as 20 % of cerebral palsy cases in term infants result from intrapartum events and up to 63 % of babies who develop intrapartum compromise have no prior risk factors. Sildenafil citrate (SC), a phosphodiesterase 5 inhibitor, improves uterine blood supply through vasodilatation and potentially could improve placental perfusion and hence reduce the risk of intrapartum fetal hypoxia. The aim of this study is to evaluate the efficacy of SC to reduce the risk of intrapartum fetal compromise and the need for emergency operative delivery. METHODS/DESIGN: This is a single centre, double-blind, randomised, phase II clinical trial of SC or placebo given during labour to women (18–50 years of age) with a single, appropriately grown, non-anomalous baby at term (37–42 weeks gestation). Those with cardiovascular, renal, hepatic, ocular or hypertensive disease or contraindication to SC will be excluded. Participants will be randomised to either SC 50 mg or placebo capsules eight hourly (SC maximum 150 mg) to commence when admitted to birth suite for management of labour. Within 3 h of the first dose, a repeat ultrasound scan will be performed to measure any changes in uteroplacental and fetal Doppler indices. Labour will continue otherwise in accordance with hospital clinical guidelines. The primary outcome is emergency caesarean section for intrapartum fetal compromise. Secondary outcomes include the effect of SC on fetal and uteroplacental blood flow, meconium liquor, fetal heart rate abnormalities and neonatal outcomes (admission to neonatal intensive care, Apgar <7 at 5 min, cord pH <7.1 or lactate >4.0 mmol/L, neonatal encephalopathy, death). CONCLUSION: This is the first reported study evaluating the efficacy of SC on reducing the risk intrapartum fetal compromise. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615000319572 BioMed Central 2016-01-14 /pmc/articles/PMC4712615/ /pubmed/26767411 http://dx.doi.org/10.1186/s12967-016-0769-0 Text en © Dunn et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Protocol
Dunn, Liam
Flenady, Vicki
Kumar, Sailesh
Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title_full Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title_fullStr Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title_full_unstemmed Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title_short Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial
title_sort reducing the risk of fetal distress with sildenafil study (ridstress): a double-blind randomised control trial
topic Protocol
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712615/
https://www.ncbi.nlm.nih.gov/pubmed/26767411
http://dx.doi.org/10.1186/s12967-016-0769-0
work_keys_str_mv AT dunnliam reducingtheriskoffetaldistresswithsildenafilstudyridstressadoubleblindrandomisedcontroltrial
AT flenadyvicki reducingtheriskoffetaldistresswithsildenafilstudyridstressadoubleblindrandomisedcontroltrial
AT kumarsailesh reducingtheriskoffetaldistresswithsildenafilstudyridstressadoubleblindrandomisedcontroltrial