Mode of Induction in Fetal Growth Restriction and Its Affects on Fetal and Maternal Outcomes

NCT ID: NCT03625518

Last Updated: 2018-08-10

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

EARLY_PHASE1

Total Enrollment

280 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-30

Study Completion Date

2021-01-31

Brief Summary

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to compare methods of induction of labor in fetal growth restriction and its effect on maternal and neonatal outcome

Detailed Description

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Intra uterine growth restriction (FGR) is a condition in which the fetus does not realize its growth potential in uterus. The excepted definitions of this condition are fetal weight estimation below the 10th percentile per gestational week. Severe growth restriction is defined as estimated weight below the 3rd percentile. It is well known that fetuses which are growth restricted are subjected to a higher degree of complications during pregnancy and delivery such as fetal distress, hypoxic damage, intra uterine fetal demise and complications in the neonatal period including prolonged NICU hospitalization, cerebral palsy, hypoxic ischemic encephalopathy and also long term affects such as neuro developmental complications.

Common practice in managing these cases is induction of labor at term around 37 weeks of gestations to prevent these complications as it established that during this time there is a substantial rise in pregnancy complications including fetal demise.

There are no clear guide lines how to induce labor in such cases and it is not known what is the safest and the most effective way to induce labor in these cases. Prior studies have found the rate of successful vaginal birth in these cases vary between 50 and 80%. There are a number of methods of labor induction and delivery available including the use of vaginal prostaglandins (PGE2) for cervical ripening, intracervical balloon catheter or planned cesarean. In most cases when aiming for vaginal delivery the choice is between ripening of the cervix with balloon catheter in combination with Pitocin or ripening with prostaglandins. It is not known which method is safer and more successful in growth restricted fetuses.

Conditions

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Fetal Growth Retardation Induction of Labor Affected Fetus / Newborn

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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prostaglandins

vaginal prostaglandins insertion (PGE2) for cervical ripening and induction

Group Type ACTIVE_COMPARATOR

prostaglandins E2

Intervention Type DRUG

insertion of vaginal PGE2 for up to 30 hours, up to two attempts for cervical ripening and induction

intracervical balloon catheter with pitocin

insertion of intra cervical balloon catheter combined with intravenous pitocin for ripening and induction of labor

Group Type ACTIVE_COMPARATOR

intracervical balloon catheter combined with pitocin

Intervention Type DEVICE

insertion of Foley catheter intra cervical and inflating the balloon with 50-60 cc of saline, with IV pitocin according to hospital protocol

Interventions

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prostaglandins E2

insertion of vaginal PGE2 for up to 30 hours, up to two attempts for cervical ripening and induction

Intervention Type DRUG

intracervical balloon catheter combined with pitocin

insertion of Foley catheter intra cervical and inflating the balloon with 50-60 cc of saline, with IV pitocin according to hospital protocol

Intervention Type DEVICE

Other Intervention Names

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dinoprostone slow release pessary

Eligibility Criteria

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Inclusion Criteria

* singleton pregnancy
* fetal growth restriction defined as estimated fetal weight between the 3rd and 10th percentile per gestational age and are intended to deliver vaginally
* Gestational age between 36 and 42 weeks
* No known fetal anomalies

Exclusion Criteria

* Fetal estimated weight below the 3rd percentile
* Known fetal anomalies
* Contraindications for vaginal delivery: breech presentation, abnormal Doppler flow velocimetry of fetal ductus venosus.
* Oligohydramnios defined as amniotic fluid index below 5 cm
* Contraindication to the use of prostaglandins
* Fetal distress requiring emergent cesarean section
* All other condition preventing vaginal delivery as decided by a senior physician
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Tel-Aviv Sourasky Medical Center

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Lis Maternity Hospital, Tel Aviv Sourasky Medical Center

Tel Aviv, , Israel

Site Status

Countries

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Israel

Central Contacts

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Ayelet Dangot, MD

Role: CONTACT

972524262658

Facility Contacts

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Michael Kuperminc, MD

Role: primary

97236925633

Ayelet Dangot, MD

Role: backup

97236925633

References

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Figueras F, Gratacos E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98. doi: 10.1159/000357592. Epub 2014 Jan 23.

Reference Type BACKGROUND
PMID: 24457811 (View on PubMed)

Baschat AA. Fetal growth restriction - from observation to intervention. J Perinat Med. 2010 May;38(3):239-46. doi: 10.1515/jpm.2010.041.

Reference Type BACKGROUND
PMID: 20205623 (View on PubMed)

Walker DM, Marlow N. Neurocognitive outcome following fetal growth restriction. Arch Dis Child Fetal Neonatal Ed. 2008 Jul;93(4):F322-5. doi: 10.1136/adc.2007.120485. Epub 2008 Apr 1.

Reference Type BACKGROUND
PMID: 18381841 (View on PubMed)

Boers KE, Vijgen SM, Bijlenga D, van der Post JA, Bekedam DJ, Kwee A, van der Salm PC, van Pampus MG, Spaanderman ME, de Boer K, Duvekot JJ, Bremer HA, Hasaart TH, Delemarre FM, Bloemenkamp KW, van Meir CA, Willekes C, Wijnen EJ, Rijken M, le Cessie S, Roumen FJ, Thornton JG, van Lith JM, Mol BW, Scherjon SA; DIGITAT study group. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ. 2010 Dec 21;341:c7087. doi: 10.1136/bmj.c7087.

Reference Type BACKGROUND
PMID: 21177352 (View on PubMed)

ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013 May;121(5):1122-1133. doi: 10.1097/01.AOG.0000429658.85846.f9.

Reference Type BACKGROUND
PMID: 23635765 (View on PubMed)

Horowitz KM, Feldman D. Fetal growth restriction: risk factors for unplanned primary cesarean delivery. J Matern Fetal Neonatal Med. 2015;28(18):2131-4. doi: 10.3109/14767058.2014.980807. Epub 2014 Nov 14.

Reference Type BACKGROUND
PMID: 25354283 (View on PubMed)

Maslovitz S, Shenhav M, Levin I, Almog B, Ochshorn Y, Kupferminc M, Many A. Outcome of induced deliveries in growth-restricted fetuses: second thoughts about the vaginal option. Arch Gynecol Obstet. 2009 Feb;279(2):139-43. doi: 10.1007/s00404-008-0685-5. Epub 2008 May 28.

Reference Type BACKGROUND
PMID: 18506461 (View on PubMed)

Other Identifiers

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0114-18

Identifier Type: -

Identifier Source: org_study_id

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