Clinical Research Directory

Comparison of 'Sip Til Send' Regimens Prior to Elective Caesarean Delivery Using Bedside Gastric Ultrasound

'Sip Til send' is a liberal drinking policy that replaces fasting before a caesarean delivery, meaning that women waiting in hospital can freely drink sips of water until they are called from the ward for their delivery. Studies has shown that 'Sip Til send' is safe and it improves the experience around surgery. Separate from this, drinking carbohydrate-rich drinks at specified time intervals before surgery is also recommended by international guidelines as part of a package of care aimed at enhancing recovery from surgery, and studies demonstrate that carbohydrate drinks significantly lower hunger sensation before caesarean delivery. The aim of this study is to combine these two interventions and compare the effects of sipping water against sipping carbohydrate drinks whilst waiting for a caesarean delivery and look at the stomach contents before delivery to ensure it is a safe practice and look at how women rate the quality of their recovery to see which practice is preferred. We will recruit women due to have an elective caesarean delivery whilst awake with a spinal anaesthetic at the Rotunda Hospital and only include those who are fully fasted on their arrival and would be candidates for the current 'Sip Til Send' policy. They will then be assigned to one of two groups, the "water" group who will be encouraged to sip water whilst waiting for surgery, and the "carbohydrate" group who will be encouraged to sip a standardised carbohydrate-rich drink instead. Using a bedside ultrasound machine, we will image the stomach and estimate the volume of liquid contents on two occasions; first, following recruitment to the study when fully fasted and before starting 'Sip Til Send', and second is immediately prior to surgery. Fluid intake will be closely monitored, and all participants will be asked to complete a short questionnaire the day after their delivery that asks them to rate aspects of their recovery. Participants and their newborns will not undergo any additional invasive testing for the study. Participants and their newborns will not undergo any additional invasive testing for the study, but consent will be sought to test women's urine for ketones (collected from the catheter bag during surgery). Medical notes will also be looked at after discharge to identify adverse outcomes such as nausea or vomiting during surgery and low blood sugar in the newborn. The study should run for approximately 3 to 6 months.

Comparison of Classic and Sequential Spinal Techniques for Preventing Hypotension During Cesarean Delivery.

Given the clinical importance of maternal hypotension, the potential advantages of sequential spinal dosing warrant formal evaluation in a prospective, adequately powered randomized controlled trial. We therefore designed this study to compare the incidence of post-spinal hypotension between the classic single-shot spinal and the sequential fractionated spinal techniques in elective cesarean delivery.

Regenerative Effects of Birth Material Derived Extracellular Vesicles

Stem cells offer great hope for a wide range of disorders, including age-related brain disease such as dementia. Mesenchymal stem cells (MSCs) are special types of adult stem cells found in various tissues like the umbilical cord, placenta and bone marrow. These cells can develop into different cell types, such as bone, cartilage, muscle, and neurones. They can promote healing, regulate the immune system and repair damaged tissues. Extracellular vesicles (EVs) are tiny, bubble-like structures released by MSCs, which help communication between tissues and organs by delivering specific instructions and regenerative substances. Therefore, MSC-EVs are thought to be responsible for many of beneficial effects. Recent evidence suggests that specific properties of EVs depend on where the MSCs come from, how old the donor was, and the environment/conditions they are in. To better understand the best source of MSC-EVs for treating age-related brain diseases, the investigators here plan to use placenta, amniotic fluid, and umbilical cord tissues of consenting mothers, who are undergoing an elective Caesarean section. Such birth tissues are rich sources of stem cells and would normally be disposed off. The investigators will here extract and analyse EVs and seek to identify the most effective ones for regenerating aged or damaged brain cells. Once the investigators identify the best source, they will seek to stabilise ("immortalize") the stem cells so that they offer a consistent source of effective MSC-EVs. Additionally, the investigators aim to modify MSCs genetically or via exposure to regenerative compounds to enhance their therapeutic properties. Promising MSC-EVs will be tested on cell culture models of brain aging and disease to validate if they can repair damage or aid recovery. Overall, the project aims to explore sources and properties of MSC-EVs that may offer new therapeutic ways to treat brain diseases.