Reviewed by Michael Gill, B. Sc.
Image of Mount Sinai Hospital in Toronto, Canada.
Phase-Based Progress Estimates
1
Effectiveness
1
Safety

Ultrasoundfor Labor Pain

18 - 65
Female
Combined spinal-epidural (CSE) for labor analgesia has been used for many years and is practiced commonly at our institution, especially when the patient requests immediate pain relief. CSE is not only beneficial for its faster onset of analgesia, but also it is favorable in relation to the need for rescue analgesia, urinary retention, and rate of instrumental delivery compared to the traditional epidural. Despite its beneficial effects, there is a risk of about 15-30% of developing abnormal fetal heart rate following CSE. This is self-resolving with minimal or no intervention. Although the cause of fetal bradycardia is not fully elucidated, variations in uterine artery blood flow after epidural analgesia are thought to be due to the interaction of numerous events related to blockade of sympathetic innervations, fluid administration, maternal hypotension, uterine vascular effects of sympathetic block, fluctuations in circulating catecholamines, and possibly the effect of opioids. Similar mechanism is thought to be a cause of fetal bradycardia after the CSE with its faster onset and superior block. Maternal or fetal circulation during labor can be assessed using continuous-wave Doppler ultrasound to monitor maternal uterine artery (UtA) and fetal umbilical artery (UmA) velocity waveforms to detect changes in blood flow. The velocimetry indices mentioned above have been often used to assess the changes in the blood flow before and after the induction of epidural analgesia during labor in several studies. Although there are some studies regarding the effect of labor epidural analgesia using velocimetry indices, but there is currently no published study evaluating velocimetry indices of uterine and umbilical arteries before and after the induction of CSE. Thus, the aim of this study is to investigate the impact of CSE to maternal and fetal blood flow to evaluate the relationships. The investigators hypothesize that both uterine artery and umbilical artery blood flow are reduced after the induction of CSE, which may be responsible for the occurrence of fetal bradycardia.
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Mount Sinai HospitalMrinalini Balki, MD
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Most Recent Ultrasound Clinical Trials

Though its use in treating neurological disorders is still in its infancy, therapeutic ultrasonography shows promise for a wide range of brain-related applications. Modern medical technology allows doctors to target a specific area of the brain to send sound waves into by using real-time thermography and magnetic resonance imaging.

What Are Ultrasound Clinical Trials?

Focused ultrasound is a platform technology that is transforming the treatment of a variety of medical conditions.

Focused ultrasound has a wide range of clinical uses currently undergoing study, development, and commercialization. This novel, non-invasive treatment has been sped up by ultrasound clinical testing.

Why Is Ultrasound Being Studied In Clinical Trials?

Since the FDA approved a focused ultrasound therapy device for uterine fibroids in 2004, it has been available to women in the United States. In 2012, the FDA cleared the technique for use in the United States to treat the pain of bone cancer. In 2015, the Food and Drug Administration approved two focused ultrasound devices for the ablation of prostate tissue.

Insightec's Exablate Neuro device has been used successfully to treat essential tremor since it was given FDA approval in July 2016. In December 2018, the same device was given the green light to treat tremor-dominant Parkinson's disease; in November 2021, the same device was given the green light to treat Parkinson's dyskinesia.

The Sonalleve MR-guided high-intensity focused ultrasound device by Profound Medical was granted a Humanitarian Device Exemption ("HDE") in December 2020 for the treatment of osteoid osteomas in the extremities.

Numerous clinical trials are in place or planned for studies that will explore other potential uses of this technology.

How Does Ultrasound Treatment Work?

Using ultrasonic energy to target tissue deep within the body without incisions or radiation, focused ultrasound is a promising early-stage, non-invasive therapeutic tool with the potential to revolutionize the treatment of many medical conditions.

The basic idea is similar to burning a hole in a leaf using a magnifying lens to concentrate sunlight at a pinpoint. Using an acoustic lens, focused ultrasound can pinpoint an inside body target with pinpoint accuracy by focusing numerous ultrasound beams at the same time. The lens's design and the ultrasound's specifications determine how big or small the target can be, from 1 to 1.5 millimeters to 10 by 16 millimeters.

There is no effect where the individual rays pass through the tissue. At the focal point, however, the many beams of focused ultrasound energy merge, producing numerous critical biological effects and opening up the prospect of treating a wide range of medical conditions.

Who Are The Key Opinion Leaders On Ultrasound Clinical Trial Research?

Neal F. Kassell, MD – chairman of the Focused Ultrasound Foundation

E Minalga - Department of Radiology, UCAIR, Salt Lake City, Utah

The past decade has seen a dramatic increase in the number of publications of studies using therapeutic ultrasonography on both animals and humans. Medical physicists, biomedical engineers, neuroradiologists, neurophysiologists, neurosurgeons, psychiatrists, and neurologists are becoming more comfortable with this new technology, and this is reflected in this advancement.

About The Author

Michael Gill preview

Michael Gill - B. Sc.

First Published: October 4th, 2021

Last Reviewed: October 18th, 2022

Michael Gill holds a Bachelors of Science in Integrated Science and Mathematics from McMaster University. During his degree he devoted considerable time modeling the pharmacodynamics of promising drug candidates. Since then, he has leveraged this knowledge of the investigational new drug ecosystem to help his father navigate clinical trials for multiple myeloma, an experience which prompted him to co-found Power Life Sciences: a company that helps patients access randomized controlled trials.

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