Continuous Remote Vital Sign Monitoring During Labour Analgesia With Remifentanil

Condition(s) studied

Investigational drug(s) / intervention(s)

Intermittent midwife absence during remote monitoring of remifentanil PCA in labour: Midwife absence during remifentanil PCA for labour analgesia. We aim to include a total of 80 participants. All will receive remifentanil PCA for labour analgesia and be monitored with remote monitoring equipment. First a group of 40 parturients will be included, and the attending midwife will not be allowed to leave the parturient (Group 1). A following group of 40 parturients will then be included and the attending midwife can leave the room in intervals up to 10 minutes (Group 2).

Study summary

Continuous remote vital sign monitoring during labour analgesia with remifentanil - a prospective observational study

Remifentanil PCA represents a well-tolerated, effective and valuable option for labour analgesia, yet its wider implementation is still limited by concerns of opioid side-effects particularly the risk of respiratory depression leading to desaturation, potentially affecting the foetus. Thus, continuous one-to-one observation and monitoring in the delivery room, with the midwife unable to leave the patient unattended, is recommended. Such constant one-to-one monitoring may be challenging in present health-care settings where staffing constraints may limit the implementation of remifentanil as routine obstetric care.

Continuous remote vital sign monitoring to display oxygen saturation (SpO₂), respiratory rate, and heart rate on a handheld device (smartphone), has the potential to address this barrier by allowing the midwife to leave the labour room for short, predefined intervals while maintaining continuous surveillance of maternal vital signs. Such an approach could free staff resources without compromising patient safety. While centralised foetal monitoring (CTG) is standard practice in many units, the application of continuous remote vital sign monitoring for women receiving remifentanil during labour has, to our knowledge, never been formally studied.

Objectives The aim is to study whether remote monitoring during remifentanil patient-controlled analgesia (PCA) for labour affects the incidence of maternal desaturation and other safety outcomes (bradypnoea, bradycardia, and neonatal outcomes, assessed via Apgar scores and umbilical cord pH.) The study will be conducted in a setting where remifentanil PCA is administered for labour analgesia and the midwife is permitted to leave the labour room for intervals of up to 10 minutes while the woman is remotely monitored using a handheld device carried by the midwife. Predefined criteria for when the woman must be accompanied (e.g., if SpO₂ \< 94%, supplemental oxygen \>2L/min., or decreased consciousness). Outcomes in this group will be compared with a control group where the midwife remains continuously present in the labour room.

Eligibility

Primary outcome measure(s)

• Incidence of SpO₂ 90-93% lasting more than 2 minutes — During labour
  During the use of remifentanil for labour analgesia.

Trial sites (1)

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