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TerminatedNCT03478163Updated Oct 7, 2021Results posted

Antibiotics During Intrauterine Balloon Tamponade Placement

A Phase 4 interventional study of CeFAZolin 1000 MG and Clindamycin 900 MG in 6 ML Injection in Obstetric Complication, Postpartum Hemorrhage and Postpartum Endometritis, sponsored by Cedars-Sinai Medical Center. Terminated at 1 site in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-10-07.

Sponsored by Cedars-Sinai Medical Center · Phase 4, Interventional, and Prevention

Why this study was terminated
Problems with recruitment
Phase
Phase 4
Study type
Interventional
Enrollment
11
Allocation
Randomized
Ages
18 Years and older
Sex
Female
01

Study summary

The goal of this study is to identify whether antibiotics given at the time of placement of an intrauterine balloon tamponade (IBT) will result in reduction of the risk of endometritis. The investigators hypothesize that antibiotics given at the time of intrauterine balloon tamponade will reduce the likelihood of postpartum endometritis.

Read the detailed description

The investigators will perform a randomized, controlled trial of women who have had a postpartum hemorrhage and received an intrauterine balloon tamponade.

Patients who are candidates for study enrollment will be identified on Labor \& Delivery or in the Maternal-Fetal Care Unit. Patients who give consent will be randomized by random number generator to receive either antibiotics (Group A) or no antibiotics (Group B).

If the patient is randomized to Group A, she will receive a 24-hour course of antibiotics. The primary antibiotic of choice will be cefazolin 1 gm iv q8 hours. If the patient has contraindications to the use of cefazolin including cefazolin allergy, hypersensitivity, or severe beta lactam allergy, then clindamycin 900 mg iv q8 hours will be used instead.

If the patient is randomized to Group B, she will not receive antibiotics as part of the study, though if at any time her provider chooses to administer antibiotics either prophylactically or for treatment she will not prohibited in any way from this or any other treatment as appropriate.

02

Conditions studied

  • Obstetric Complication
  • Postpartum Hemorrhage
  • Postpartum Endometritis

Keywords

  • Bakri
  • Intrauterine balloon tamponade
  • Antibiotics
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  • Female
  • Able to give consent
  • Gestational age > 24 weeks
  • Postpartum
  • Placement of an IBT within the last 2 hours with plans for it to remain in situ for at least 2 hours
  • Primary obstetrician amenable to proceeding with either method of management during the study period.

Exclusion criteria

Exclusion Criteria:

  • Age \< 18 years old
  • IBT removed within 2 hours of placement
  • Chorioamnionitis
  • Insufficient documentation of demographics, delivery outcomes, or peripartum events including postpartum hemorrhage, infectious outcomes
04

Study design

Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
11 participants (actual)

Study arms

  • No intervention
    Control

    The patient will not receive antibiotics as part of the study, though if at any time her provider chooses to administer antibiotics either prophylactically or for treatment she will not prohibited in any way from this or any other treatment as appropriate.

  • Experimental
    Antibiotics

    The patient will receive a 24-hour course of antibiotics. The primary antibiotic of choice will be cefazolin 1 gm iv q8 hours. If the patient has contraindications to the use of cefazolin including cefazolin allergy, hypersensitivity, or severe beta lactam allergy, then clindamycin 900 mg iv q8 hours will be used instead.

    Drug: CeFAZolin 1000 MG · Drug: Clindamycin 900 MG in 6 ML Injection

Interventions

  • DrugCeFAZolin 1000 MG

    Cefazolin 1000 mg every 8 hours for 3 doses

  • DrugClindamycin 900 MG in 6 ML Injection

    Clindamycin 900 mg every 8 hours for 3 doses

05

What researchers measure

Primary outcomes

  1. Postpartum Endometritis

    Number of participants with postpartum endometritis as defined by clinical documentation

    Time frame: 6 weeks

Secondary outcomes

  1. Number of Participants With a Fever

    Number of participants with a fever \> 38 degrees celsius

    Time frame: 6 weeks

  2. Receiving Postpartum Antibiotics

    Receiving postpartum antibiotics

    Time frame: 6 weeks

  3. Hysterectomy

    Hysterectomy

    Time frame: 6 weeks

  4. EBL

    Estimated blood loss prior to removal and with IBT in

    Time frame: 2 weeks

  5. Postpartum Hemoglobin

    Postpartum hemoglobin value

    Time frame: 2 weeks

  6. Blood Transfusion

    Blood transfusions

    Time frame: 2 weeks

  7. Maternal ICU Admission

    Maternal ICU Admission

    Time frame: 6 weeks

  8. Maternal Death

    Maternal death

    Time frame: 6 weeks

  9. Resource Utilization Measures

    Duration of admission to maternal-fetal care unit and total hospital admission length of stay

    Time frame: 6 weeks

  10. Hospital Readmission

    Hospital readmission

    Time frame: 6 weeks

06

Results

Posted Oct 7, 2021

Participant flow

Participant flow — Overall Study
MilestoneControlAntibiotics
Started56
Completed56
Not completed00

Outcome measures

PrimaryPostpartum Endometritis

Number of participants with postpartum endometritis as defined by clinical documentation

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Postpartum Endometritis
ParticipantsControlAntibiotics
Postpartum Endometritis03
SecondaryNumber of Participants With a Fever

Number of participants with a fever \> 38 degrees celsius

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Number of Participants With a Fever
ParticipantsControlAntibiotics
Number of Participants With a Fever03
SecondaryReceiving Postpartum Antibiotics

Receiving postpartum antibiotics

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Receiving Postpartum Antibiotics
ParticipantsControlAntibiotics
Receiving Postpartum Antibiotics03
SecondaryHysterectomy

Hysterectomy

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Hysterectomy
ParticipantsControlAntibiotics
Hysterectomy00
SecondaryEBL

Estimated blood loss prior to removal and with IBT in

Time frame:
2 weeks
Reported as:
Mean · cc
EBL
ccControlAntibiotics
Estimated Blood Loss Pre-IBT1626 (1400 to 1800)1385.83 (965 to 1800)
Estimated Blood Loss with IBT in165.6 (115 to 295)197 (80 to 430)
SecondaryPostpartum Hemoglobin

Postpartum hemoglobin value

Time frame:
2 weeks
Reported as:
Mean · g/dL
Postpartum Hemoglobin
g/dLControlAntibiotics
Postpartum Hemoglobin9.52 (9 to 10.3)9.23 (8 to 10.7)
SecondaryBlood Transfusion

Blood transfusions

Time frame:
2 weeks
Reported as:
Count of participants · Participants
Blood Transfusion
ParticipantsControlAntibiotics
0 RBC Transfusions30
1 RBC Transfusions02
2 RBC Transfusions22
3 RBC Transfusions01
SecondaryMaternal ICU Admission

Maternal ICU Admission

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Maternal ICU Admission
ParticipantsControlAntibiotics
Maternal ICU Admission00
SecondaryMaternal Death

Maternal death

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Maternal Death
ParticipantsControlAntibiotics
Maternal Death00
SecondaryResource Utilization Measures

Duration of admission to maternal-fetal care unit and total hospital admission length of stay

Time frame:
6 weeks
Reported as:
Mean · hours
Resource Utilization Measures
hoursControlAntibiotics
MFCU Length of Stay29.75 (19 to 53)30.67 (20 to 40)
Total Hospital Length of Stay83.75 (71 to 104)88.83 (64 to 122)
SecondaryHospital Readmission

Hospital readmission

Time frame:
6 weeks
Reported as:
Count of participants · Participants
Hospital Readmission
ParticipantsControlAntibiotics
Hospital Readmission00

Adverse events

Collected over 6 weeks. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Control0/5 (0%)0/5 (0%)0/5 (0%)
Antibiotics0/6 (0%)0/6 (0%)0/6 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)ControlAntibioticsTotal
Mean36 (30 to 41)33.83 (27 to 39)34.82 (27 to 41)
Sex: Female, Male
Sex: Female, Male(Participants)ControlAntibioticsTotal
Female5611
Male000
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)ControlAntibioticsTotal
Hispanic or Latino112
Not Hispanic or Latino459
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)ControlAntibioticsTotal
American Indian or Alaska Native000
Asian000
Native Hawaiian or Other Pacific Islander000
Black or African American033
White437
More than one race000
Unknown or Not Reported101
Gravidity
Gravidity(pregnancies)ControlAntibioticsTotal
Mean3 (2 to 4)1.67 (0 to 3)2.27 (0 to 4)
Parity
Parity(pregnancies)ControlAntibioticsTotal
Mean1 (0 to 2)0.33 (0 to 1)0.64 (0 to 2)
Preexisting Hypertension
Preexisting Hypertension(Participants)ControlAntibioticsTotal
Count of participants011
Gestational Hypertension or Preeclampsia
Gestational Hypertension or Preeclampsia(Participants)ControlAntibioticsTotal
Count of participants000

14 further baseline measures are reported on the registry.

07

Study locations

1 site
  • Cedars-Sinai Medical Center
    Los Angeles, California 90048, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Mar 15, 2018

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT03478163
Lead sponsor
Cedars-Sinai Medical Center
Responsible party
Kimberly Gregory (Director, Women's Reproductive Health Services, Cedars-Sinai Medical Center) — Principal investigator
First posted
Mar 27, 2018
Start date
Mar 8, 2018
Primary completion
May 3, 2021
Completion
May 3, 2021
Results posted
Oct 7, 2021
Last update
Oct 7, 2021

Study contacts

Kimberly Gregory, MD MPH
principal investigator · Cedars-Sinai Medical Center

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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