Detection of Preterm Labour by Cervical Length

NCT ID: NCT04104984

Last Updated: 2020-01-14

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

966 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-15

Study Completion Date

2021-11-15

Brief Summary

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Detection of short cervix by transvaginal ultrasound and its evidence based management to prevent preterm birth .

Detailed Description

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* All pregnant women will attend hospital between 14-24 weeks and fulfil inclusion and exclusion criteria will be approached for possibility to be included in the study .
* History taking .Obstetric history will be obtained from the patient includes gravidity and parity , last menstrual period , duration of gestation at birth time , mode of delivery , gender, birth Wight, any complication in each pregnancy, miscarriage and causes of miscarriage . Past history will be obtained from the patient for any medical disease like ( severe anaemia, hypertensive disease, heart disease, antiretroviral therapy in pregnancy and genitourinary infection) and History of cervical cercalage . Family history will be obtained to determine any history of family preterm birth. Socioeconomic status will be obtained include occupation and financial status. Special Habits for both couples.

* Gynaecological history will be taken from the patient include any vaginal bleeding, history of vaginal infection, operations like D and C with cervical dilatation.
* Examination Examination of the patient include vital signs, general examination ( head, neck ,chest ,heart ) obstetric examination include inspection, palpation, auscultation and speculum vaginal examination.
* -Investigation Investigation includes antenatal care laboratory tests like urine analysis ,CBC, RH factor and random blood sugar .
* Transvaginal ultrasound:

Study group : Cervical length will be measured using transvaginal ultrasonography with the standard longitudinal view of cervix while patient's bladder is empty. TVS probe will be used to measure cervical length. It will be measured by keeping the probe 3cm away from the posterior fornix. The cervical length is defined as the length between the internal OS and external OS

Those with short cervix less than 25 mm will be managed According to NICE guide lines :

Offer a choice of either prophylactic vaginal progesterone or prophylactic cervical cerclage to women: with a history of spontaneous preterm birth or mid-trimester loss between 16+0 and 34+0 weeks of pregnancy and in whom a transvaginal ultrasound scan has been carried out between 16+0 and 24+0 weeks of pregnancy that reveals a cervical length of less than 25 mm.

Discuss the benefits and risks of prophylactic progesterone and cervical cerclage with the woman and take her preferences into account.

Offer prophylactic vaginal progesterone to women with no history of spontaneous preterm birth or mid-trimester loss in whom a transvaginal ultrasound scan has been carried out between 16+0 and 24+0 weeks of pregnancy that reveals a cervical length of less than 25 mm.

Consider prophylactic cervical cerclage for women in whom a transvaginal ultrasound scan has been carried out between 16+0 and 24+0 weeks of pregnancy that reveals a cervical length of less than 25 mm and who have either: had preterm prelabour rupture of membranes (P-PROM) in a previous pregnancy or a history of cervical trauma (17) .

progesterone will be given in form of vaginal suppository 200 mg once daily . Start receiving it once diagnoses is established till 34 week gestation.

A McDonald cerclage will be be preformed for women once diagnoses is established and removed at 36 week gestational or when labour pain start.

Control group : All pregnant women who fulfil the same inclusion criteria, exclusion criteria, diagnoses established as short cervix by digital vaginal exam or trans abdominal ultrasound or not specified and do not undergo transvaginal ultrasound assessment , and do not managed according to NICE guide lines will be treated and managed according to their units as a control group.

• Then all patients will be followed up every 4 weeks by taking history , any complaint of new symptoms , compliance to treatment, obstetric exam and investigation if indicated till delivery and record the time of delivery or termination of pregnancy. After delivery, record maternal and fetal outcome.

Conditions

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Preterm Labour

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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control group not follow NICE guide lines

All pregnant women who fulfil the same inclusion criteria, exclusion criteria, diagnoses established as short cervix , and do not managed according to NICE guide lines will be treated and managed according to their units as a control group.

Group Type EXPERIMENTAL

digital vaginal exam

Intervention Type OTHER

vaginal examination to detect short cervix

abdominal ultrasound

Intervention Type DEVICE

use abdominal ultrasound to measure cervical length

Tocolytic Agents

Intervention Type DRUG

a medication is given to prevent uterine contraction

study group follow NICE guide lines

\- All pregnant women will attend hospital between 14-24 weeks and fulfil inclusion and exclusion criteria will be approached for possibility to be included in the study . and will be managed according NICE guide lines

Group Type EXPERIMENTAL

transvaginal ultrasound

Intervention Type DEVICE

a transvaginal ultrasound is done to patient to determine cervical length

Progesterone Vaginal Suppository

Intervention Type DRUG

a progesterone vaginal suppository to prevent preterm labour

cervical cercalage

Intervention Type PROCEDURE

Mcdonald's cervical cercalage . a stitch taken around the cervix to prevent preterm labour

Interventions

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transvaginal ultrasound

a transvaginal ultrasound is done to patient to determine cervical length

Intervention Type DEVICE

Progesterone Vaginal Suppository

a progesterone vaginal suppository to prevent preterm labour

Intervention Type DRUG

cervical cercalage

Mcdonald's cervical cercalage . a stitch taken around the cervix to prevent preterm labour

Intervention Type PROCEDURE

digital vaginal exam

vaginal examination to detect short cervix

Intervention Type OTHER

abdominal ultrasound

use abdominal ultrasound to measure cervical length

Intervention Type DEVICE

Tocolytic Agents

a medication is given to prevent uterine contraction

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* pregnant women with gestational age between 14-24 weeks and having singletone or multiple viable fetus

Exclusion Criteria

.Current Cervical cercalage.

* Major Fetal malformation .
* Prenatal infection (bacterial vaginosis ) .Medical comorbidities . .Currently receiving Progesterone treatment. .Pregnancy from assisted reproductive technique . .Threatened miscarriage . .Rupture membrane. .Painful uterine contraction. .Low implanted placenta.
Minimum Eligible Age

16 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Shehab Alam Millad

principle investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alaa Eldeen M Ismail, MD

Role: PRINCIPAL_INVESTIGATOR

Asssiut University

Ahmed M Alaa eldeen, MD

Role: PRINCIPAL_INVESTIGATOR

Assiut University

Hany A Ali, MD

Role: PRINCIPAL_INVESTIGATOR

Asssiut University

Central Contacts

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Shehab A Millad, MD

Role: CONTACT

+201206507003

Other Identifiers

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VUS cervical Length

Identifier Type: -

Identifier Source: org_study_id

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