Does Nipple Stimulation Shorten Time to Vaginal Birth in Women With Term PROM?

NCT ID: NCT03025581

Last Updated: 2017-01-19

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-01-31

Study Completion Date

2018-01-31

Brief Summary

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Premature Rupture of Membranes (PROM) is defined as the rupture of membranes before the onset of regular uterine contractions.

PROM occurs in approximately 10% of all pregnancies (ranging from 2.7% to 17%), with 60% to 80% of cases occurring at term. Approximately 90% of patients' experience PROM enter spontaneous labor within 24 hours, but disagreement exists among health care providers on the optimal management of women with PROM, particularly the need for and timing of inductions.

Nipple stimulation is a non-medical natural method for induction of labor. Previous studies demonstrated its effectiveness for initiating labor within 72 hours in women with favorable cervices. The actual mechanism by which such a technique results in cervical ripening is not well understood.

In this study, we aim to assess the effectiveness of nipple stimulation in gravid women with term PROM choosing expectant management.

Detailed Description

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The participants in the study will be randomized into two groups of expectant management (patients desire an active approach will be excluded).

All eligible participants will be randomly allocated to either intervention or control group. They will be followed from the time of presentation with rupture of membranes at the ER and until the time of delivery. Prophylactic antibiotics will be administered after 18 hours from rupture of membranes as per departmental policy.

On admission, and after validating inclusion criteria, women will be offered to join the study. For the intervention group women will be instructed to gently massage alternate breasts, especially around the nipples for 15 minutes every 6 hours until the appearance of regular contractions but not more than 24 hours. Moist cloth or lubricating or moisturizing cream will be offered to facilitate the procedure according to individual preferences. In the control group all participants will be asked to avoid any breast stimulation during the study period.

For both groups maternal surveillance will include obstetrician assessment every 6 hours or per maternal request if painful contractions. Every assessment will include documenting maternal vital signs, sense of contraction, fetal cardiotocographic assessment and vaginal examination if painful contractions. After delivery,all participants will be requested to fill a satisfaction questionnaire.

Conditions

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Premature Rupture of Fetal Membranes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Blinding Strategy

NONE

Study Groups

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Intervention group

Nipple stimulation.

Group Type ACTIVE_COMPARATOR

Nipple stimulation

Intervention Type OTHER

For the intervention group participants will be instructed to gently massage alternate breasts, especially around the nipples for 15 minutes every 6 hours until the appearance of regular contractions but not more than 24 hours. Moist cloth or lubricating or moisturizing cream will be offered to facilitate the procedure according to individual preferences. In the control group all participants will be asked to avoid any breast stimulation during the study period.

Control group

No intervention (expectant management only).

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Nipple stimulation

For the intervention group participants will be instructed to gently massage alternate breasts, especially around the nipples for 15 minutes every 6 hours until the appearance of regular contractions but not more than 24 hours. Moist cloth or lubricating or moisturizing cream will be offered to facilitate the procedure according to individual preferences. In the control group all participants will be asked to avoid any breast stimulation during the study period.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Primagravidas at term (\>37) weeks having PROM
* Singleton pregnancies
* Cephalic presentation
* Unfavorable cervix (Bishop score \<7)
* Desire an expectant management

Exclusion Criteria

* Prior cesarean section/ uterine rupture / transmural uterine incision
* Non reassuring fetal heart rate monitoring (Category III)
* Signs of fetal or maternal infection
* Time elapsed since PROM \> 6 hours
* Meconium or blood-stained amniotic fluid
* Any contraindication for vaginal birth
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Hillel Yaffe Medical Center

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mordechai Hallak, M.D

Role: PRINCIPAL_INVESTIGATOR

Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera

Rinat Gabbay, M.D

Role: STUDY_DIRECTOR

Department of Obstetrics & Gynecology, Hillel Yaffe Medical Center, Hadera

Locations

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Hillel Yaffe Medical Center

Hadera, , Israel

Site Status

Countries

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Israel

Central Contacts

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Ofer Limonad, M.D

Role: CONTACT

Esti Maor, M.D

Role: CONTACT

Facility Contacts

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Ofer Limonad, M.D

Role: primary

Esti Maor, M.D

Role: backup

References

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Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, Wang EE, Weston JA, Willan AR. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med. 1996 Apr 18;334(16):1005-10. doi: 10.1056/NEJM199604183341601.

Reference Type RESULT
PMID: 8598837 (View on PubMed)

Cahill AG, Tuuli MG. Labor in 2013: the new frontier. Am J Obstet Gynecol. 2013 Dec;209(6):531-4. doi: 10.1016/j.ajog.2013.04.016. Epub 2013 Apr 10.

Reference Type RESULT
PMID: 23583208 (View on PubMed)

Christensson K, Nilsson BA, Stock S, Matthiesen AS, Uvnas-Moberg K. Effect of nipple stimulation on uterine activity and on plasma levels of oxytocin in full term, healthy, pregnant women. Acta Obstet Gynecol Scand. 1989;68(3):205-10. doi: 10.3109/00016348909020990.

Reference Type RESULT
PMID: 2618602 (View on PubMed)

Elliott JP, Flaherty JF. The use of breast stimulation to ripen the cervix in term pregnancies. Am J Obstet Gynecol. 1983 Mar 1;145(5):553-6. doi: 10.1016/0002-9378(83)91194-8.

Reference Type RESULT
PMID: 6338721 (View on PubMed)

Elliott JP, Flaherty JF. The use of breast stimulation to prevent postdate pregnancy. Am J Obstet Gynecol. 1984 Jul 15;149(6):628-32. doi: 10.1016/0002-9378(84)90247-3.

Reference Type RESULT
PMID: 6377899 (View on PubMed)

Hill WC, Moenning RK, Katz M, Kitzmiller JL. Characteristics of uterine activity during the breast stimulation stress test. Obstet Gynecol. 1984 Oct;64(4):489-92.

Reference Type RESULT
PMID: 6483296 (View on PubMed)

Johnson JW, Daikoku NH, Niebyl JR, Johnson TR Jr, Khouzami VA, Witter FR. Premature rupture of the membranes and prolonged latency. Obstet Gynecol. 1981 May;57(5):547-56.

Reference Type RESULT
PMID: 7219903 (View on PubMed)

Kavanagh J, Kelly AJ, Thomas J. Breast stimulation for cervical ripening and induction of labour. Cochrane Database Syst Rev. 2005 Jul 20;2005(3):CD003392. doi: 10.1002/14651858.CD003392.pub2.

Reference Type RESULT
PMID: 16034897 (View on PubMed)

Leake RD, Buster JE, Fisher DA. The oxytocin secretory response to breast stimulation in women during the menstrual cycle. Am J Obstet Gynecol. 1984 Feb 15;148(4):457-60. doi: 10.1016/0002-9378(84)90726-9.

Reference Type RESULT
PMID: 6696003 (View on PubMed)

Mishanina E, Rogozinska E, Thatthi T, Uddin-Khan R, Khan KS, Meads C. Use of labour induction and risk of cesarean delivery: a systematic review and meta-analysis. CMAJ. 2014 Jun 10;186(9):665-73. doi: 10.1503/cmaj.130925. Epub 2014 Apr 28.

Reference Type RESULT
PMID: 24778358 (View on PubMed)

Salmon YM, Kee WH, Tan SL, Jen SW. Cervical ripening by breast stimulation. Obstet Gynecol. 1986 Jan;67(1):21-4.

Reference Type RESULT
PMID: 3940333 (View on PubMed)

Viegas OA, Arulkumaran S, Gibb DM, Ratnam SS. Nipple stimulation in late pregnancy causing uterine hyperstimulation and profound fetal bradycardia. Br J Obstet Gynaecol. 1984 Apr;91(4):364-6. doi: 10.1111/j.1471-0528.1984.tb05924.x.

Reference Type RESULT
PMID: 6712896 (View on PubMed)

Other Identifiers

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0091-HYMC

Identifier Type: -

Identifier Source: org_study_id

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