Cabergoline for Lactation Inhibition After Early Second-Trimester Abortion or Pregnancy Loss

Stanford University69 enrolled

Overview

Breast pain following second-trimester abortion is common. Breast engorgement and milk leakage following second-trimester perinatal loss and abortion can cause both physical pain and emotional distress. Dopamine agonists have previously been shown to be effective in lactation inhibition for third-trimester fetal/neonatal loss or contraindications to breastfeeding. The investigator's prior work demonstrated that compared to placebo, a single dose of cabergoline was effective in preventing breast symptoms after abortion or loss 18-28 weeks. As lactogenesis starts as early as 16 weeks gestation, the investigators hope to determine the efficacy of cabergoline earlier in the second trimester,16-20 weeks.

This study is a double-blinded, placebo-controlled, gestational-age stratified superiority trial of those undergoing abortion or intrauterine fetal demise between 16 and 20-weeks gestation at Stanford Health Care. Participants will be randomized to either cabergoline 1 mg or placebo the day of procedure. Participants will complete a survey to assess symptoms, using the validated Bristol Breast Symptoms Inventory, and side-effects at baseline and Day 2, 4, 7, and 14 after the procedure. The study plan is to recruit 72 subjects powered to detect a 45% decrease in those reporting breast symptoms compared to the control group. This study has the potential to improve overall patient experience by validating the routine use of cabergoline for lactation inhibition in the early second-trimester after abortion or pregnancy loss.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

Conditions

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pregnant people, ages 18 years or older * Intrauterine pregnancy between 16/0-19/6 weeks of gestation age (by ultrasound dating performed prior to or same day of enrollment visit) * Consented for an induced, elective abortion or undergoing management of fetal demise * English or Spanish speaking * Able to consent for a research study, literate in English or Spanish * Willing to comply with study procedures and follow-up * Access to smart phone throughout study Exclusion Criteria: 18 Years Female No No Inclusion Criteria: * Pregnant people, ages 18 years or older * Intrauterine pregnancy between 18/0-28/0 weeks of gestation age (by ultrasound dating performed prior to or same day of enrollment visit) * Consented for an induced, elective abortion or undergoing induction for demise * English or Spanish speaking * Able to consent for a research study, literate in English or Spanish * Willing to comply with study procedures and follow-up * Access to smart phone throughout study Exclusion Criteria: * Prior mastectomy (breast reduction or chest masculinization surgery acceptable) * Currently breastfeeding * Currently receiving dopamine agonist or antagonist therapy for other indication leg syndrome) * Contraindication to cabergoline (as per package insert) * Uncontrolled hypertension - defined as baseline BP \> 160/110, or chronic hypertension requiring more than one baseline medication, or current pregnancy-induced hypertension spectrum disorders (gestational hypertension, preeclampsia, eclampsia) * History of cardiac valvular disorders or valvular repair * History of pulmonary, pericardial, or retroperitoneal fibrotic disorders

Outcomes

Primary Outcomes

Number of Participants Reporting Breast Pain

Participants will assess their breast symptoms using the validated Bristol Breast Inventory survey to assess 4 domains of breast symptoms: tenderness, engorgement, leaking milk, pain relief. Participants who indicated symptoms in any of these areas met the criteria for this outcome.

Time frame: Day 4 after procedure

Secondary Outcomes

Number of Participants Experiencing Side-effects

Participants selected from previously documented side-effects from the dopaminergic class or entered as free-text. Participants may have reported more than one side-effect. The experience of dopaminergetic medication side effects may or may not be considered to be adverse events.

Time frame: Cumulative over 2 weeks

Number of Participants Reporting Significant Bother From Breast Pain

Assessed using a Facial Pain Score; scale range 0-6 (higher scores indicate greater pain), with significant bother \>=4