The Balloon Project for Birth Induction

NCT ID: NCT01255839

Last Updated: 2010-12-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

825 participants

Study Classification

INTERVENTIONAL

Study Start Date

2002-12-31

Study Completion Date

2010-12-31

Brief Summary

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The use of prostaglandin E2 (PGE2) for induction of labour in women with unfavourable cervices is well-established1. There are, however, potential side effects to prostaglandins, in particular the risk of uterine hypertonicity which may affect fetal outcome. In theory a mechanical ripening based on dilatation of the cervix as well as induction of production of endogenous prostaglandin has potentially less influence on the fetal outcome but a Cochrane review from 2001 scrutinized studies on mechanical ripening versus placebo/no treatment or prostaglandin E2. They conclude there is insufficient data to evaluate the effectiveness in terms of likelihood of vaginal delivery in 24 hours, and emphasise the need for large sample size studies and substantive outcomes. Two later randomised studies compared mechanical ripening to PGE2 and found discrepant results regarding time from induction to delivery.

The primary purpose of the present study was in a randomized design to compare the efficacy of double-balloon catheter versus vaginal PGE2 (minprostin 3 mg) on induction of labour, duration of birth and fetal outcome. Secondary analyses were to evaluate the results for various subgroups, i.e. primipara/multipara, gemelli, vaginal birth after caesarean, preterm birth and intra uterine growth restriction.

Detailed Description

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The study was a multicenter randomized study conducted at 7 labour yards in Denmark (Glostrup, Hillerød, Svendborg, Rigshospitalet, Næstved, Frederiksberg and Hvidovre). Participants were included from December 11 2002 till September 29 2005 after approval from The Danish National Committee on Biomedical Research Ethics and the data legislation. All participants were included after written and oral informed consent.

Eligible for inclusion were pregnancies with intact fetal membranes, vertex position and unripe cervix (Bishop score \< 6) who had usual indications for induction of labour, i.e. prolonged pregnancy, pre-eclampsia/ hyper-tension, placental insufficiency, diabetes mellitus and twins.

Women were excluded under the following circumstances: Spontaneous labour or rupture of membranes, placenta previa, acute fetal distress, specific infections vagina/cervix (GBS, condyloma, acute herpes), asthma, glaucoma and allergy to latex. The participants were randomised to treatment arm by 'telephonic automatic voice response system randomisation'.

Induction of labour methods The balloon group The Double Balloon Catheter was applied (Atad 5) with 80 ml NaCl installed intrauterine above the intern orificium and 80 ml below in cervix/vagina. The Balloon catheter was inserted in the evening (8-9 p.m.) if the Bishop-score was below 6, however if the score was above 6 or the insertion was impossible the participant was considered failure. The catheter was removed after 12 h (or before if needed). The labour induction was continued by amniotomy either directly or after 2 hours mobilisation and laxative or after additional 2 hours of intravenous syntocinon drip. If by then amniotomy was not possible the participant was considered failure. After amniotomy if necessary for progression of contractions intravenous oxytocin-drip was started for 2-3 hours (figure 1). If further induction was necessary the participant was considered failure.

The minprostin group The prostaglandin 2 minprostin (3mg) was applied vaginally in the morning the day of induction if Bishop score was 6 or below. After 4-5 hours a second minprostin was inserted if amniotomy was not possible. If the labour was not induced the first day the procedure it was repeated the following day. If labour was not established within 48 hours after the first minprostin the participant was considered failure.

Conditions

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Induction Time Apgar Score Admission to Neonatal Unit Vaginal Delivery Caesarean Section

Keywords

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double-balloon balloon catheter prostaglandin minprostin induction of labour fetal outcome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Double-balloon

The Double Balloon Catheter was applied (Atad 5) with 80 ml NaCl installed intrauterine above the intern orificium and 80 ml below in cervix/vagina.

Group Type ACTIVE_COMPARATOR

Double Balloon

Intervention Type DEVICE

The Double Balloon Catheter was applied (Atad 5) with 80 ml NaCl installed intrauterine above the intern orificium and 80 ml below in cervix/vagina.

Prostglandin E2

The prostaglandin 2 minprostin (3mg) was applied vaginally

Group Type ACTIVE_COMPARATOR

Minprostin

Intervention Type DRUG

The prostaglandin 2 minprostin (3mg) was applied vaginally

Interventions

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Double Balloon

The Double Balloon Catheter was applied (Atad 5) with 80 ml NaCl installed intrauterine above the intern orificium and 80 ml below in cervix/vagina.

Intervention Type DEVICE

Minprostin

The prostaglandin 2 minprostin (3mg) was applied vaginally

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* pregnancies with intact fetal membranes
* vertex position
* unripe cervix Bishop score \< 6)
* usual indications for induction of labour, i.e. prolonged pregnancy, pre-eclampsia/ hyper-tension, placental insufficiency, diabetes mellitus and twins

Exclusion Criteria

* Spontaneous labour or rupture of membranes
* placenta previa
* acute fetal distress
* specific infections vagina/cervix (GBS, condyloma, acute herpes)
* asthma
* glaucoma
* allergy to latex
Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Glostrup University Hospital, Copenhagen

OTHER

Sponsor Role lead

Responsible Party

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Department obstetrics and gynecology

Locations

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Glostrup University Hospital

Glostrup Municipality, Glostrup, Denmark

Site Status

Countries

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Denmark

Other Identifiers

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H-KA-01177-M

Identifier Type: -

Identifier Source: org_study_id