Abdominal Ultrasound Assessment in the Post-cesarean Patient
| Status: | Recruiting |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 12 - 60 |
| Updated: | 4/21/2016 |
| Start Date: | June 2014 |
| End Date: | December 2016 |
| Contact: | Brittney Thele |
| Email: | bthele@nm.org |
| Phone: | (312) 472-4683 |
This study is designed to see if abdominal ultrasound after planned cesarean delivery can
identify women with ongoing intra-abdominal bleeding.
identify women with ongoing intra-abdominal bleeding.
Hemorrhage is the second leading cause of maternal mortality in the United States. Women
have an increased risk of hemorrhage after cesarean sections.Uterine atony is the culprit in
80% of cases, but in the post-operative patient, an intra-abdominal bleed requiring a return
to the operating room must also be considered. The Focused Assessment with Sonography in
Trauma (FAST) has been used in the emergency department to evaluate for intra-abdominal
bleeding after trauma. FAST evaluation has not been studied in the post-operative period for
evaluation for intra-abdominal bleeding. Ultrasound is a rapid and readily-available
modality for this type of evaluation, and obstetricians are already familiar with the
technology. But one must be cautious, as a certain amount of free fluid on CT is common in
the postoperative patient. Before basing clinical decisions on a FAST scan, we much
determine how much fluid is normal in a patient after cesarean delivery. We hypothesize that
a certain amount of fluid in the abdomen visualized by ultrasound may be normal after a
cesarean delivery, and that for ultrasound to become a valuable modality to assess for
intra-abdominal bleeding in the post-cesarean patient, the amount of normal fluid must be
determined. However, in order to interpret what an "appropriate" amount of fluid would be,
we will also need an assessment of patient hemoglobin levels. Thus, we would additionally
plan to validate a rapid, non-invasive hemoglobin measurement for use in the post-cesarean
obstetric patient. The Pronto7 device measures the blood's absorption of multiple
wavelengths of light to determine hemoglobin. The device avoids a blood draw and its
associated pain. It also provides immediate results. We anticipate that we will identify an
association between the amount of fluid seen on ultrasonographic evaluation after cesarean
delivery and adverse outcomes such as larger than expected decrease in hemoglobin, need for
transfusion and need for take-back to the operating room. We also anticipate that the use of
non-invasive hemoglobin measurements may provide a rapid, painless assessment of
postoperative hemoglobin; this may allow us to identify patients who merit earlier
postoperative monitoring with a traditional CBC. It may also allow us to identify women who
do not need an invasive CBC on postoperative day 1, which may decrease blood draws and costs
in the future.
have an increased risk of hemorrhage after cesarean sections.Uterine atony is the culprit in
80% of cases, but in the post-operative patient, an intra-abdominal bleed requiring a return
to the operating room must also be considered. The Focused Assessment with Sonography in
Trauma (FAST) has been used in the emergency department to evaluate for intra-abdominal
bleeding after trauma. FAST evaluation has not been studied in the post-operative period for
evaluation for intra-abdominal bleeding. Ultrasound is a rapid and readily-available
modality for this type of evaluation, and obstetricians are already familiar with the
technology. But one must be cautious, as a certain amount of free fluid on CT is common in
the postoperative patient. Before basing clinical decisions on a FAST scan, we much
determine how much fluid is normal in a patient after cesarean delivery. We hypothesize that
a certain amount of fluid in the abdomen visualized by ultrasound may be normal after a
cesarean delivery, and that for ultrasound to become a valuable modality to assess for
intra-abdominal bleeding in the post-cesarean patient, the amount of normal fluid must be
determined. However, in order to interpret what an "appropriate" amount of fluid would be,
we will also need an assessment of patient hemoglobin levels. Thus, we would additionally
plan to validate a rapid, non-invasive hemoglobin measurement for use in the post-cesarean
obstetric patient. The Pronto7 device measures the blood's absorption of multiple
wavelengths of light to determine hemoglobin. The device avoids a blood draw and its
associated pain. It also provides immediate results. We anticipate that we will identify an
association between the amount of fluid seen on ultrasonographic evaluation after cesarean
delivery and adverse outcomes such as larger than expected decrease in hemoglobin, need for
transfusion and need for take-back to the operating room. We also anticipate that the use of
non-invasive hemoglobin measurements may provide a rapid, painless assessment of
postoperative hemoglobin; this may allow us to identify patients who merit earlier
postoperative monitoring with a traditional CBC. It may also allow us to identify women who
do not need an invasive CBC on postoperative day 1, which may decrease blood draws and costs
in the future.
Inclusion Criteria:
- Pregnant
- 18 years of age or older
- English-speaking
- Non-urgent cesarean sections
Exclusion Criteria:
- Preeclampsia/eclampsia
- <18 years old
- Urgent/emergent cesarean section
- Not English-speaking
- Unable to consent
We found this trial at
1
site
303 East Superior Street
Chicago, Illinois 60611
Chicago, Illinois 60611
Principal Investigator: Dana R Gossett, MD, MSCI
Phone: 312-472-4683
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