Pessary Versus Progesterone in Singletons

NCT ID: NCT04300322

Last Updated: 2020-10-09

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

804 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-01

Study Completion Date

2022-12-01

Brief Summary

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This study compares the effectiveness of cervical pessary to vaginal progesterone for prevention of preterm birth in women with singleton pregnancies and a cervix ≤25 mm.

Participants will be randomly assigned in a 1:1 ratio to receive cervical pessary or vaginal progesterone.

Detailed Description

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This open label, multi-center, randomized controlled trial aims to compare the effectiveness of cervical pessary to vaginal progesterone for prevention of PTB in women with singleton pregnancies and a cervix ≤25 mm.

All women at 16 0/7 to 22 0/7 weeks with singleton pregnancies will undergo cervical length (CL) measurement and digital examination at screening routinely. Women with a CL ≤25 mm will be eligible for the study.

Subjects meeting the study criteria will be randomized into two groups: (1) treated with cervical pessary (Arabin) or (2) treated with 200 mg vaginal progesterone, once daily.

After written informed consent, women will be randomly assigned in a 1:1 ratio to receive a cervical pessary or progesterone. Assignment to treatment allocation will be done via a web portal hosted by HOPE Research Center, Vietnam. The randomization schedule will be computer-generated at HOPE Research Center, with a permuted random block size of 2, 4 or 6. Blinding will not be possible due to the nature of interventions.

For those who randomised to pessary group, a pessary certified by European Conformity (Arabin®, Dr Arabin GmbH \& Co KG, Germany) will be inserted through the vagina, upward around the cervix by 2-4 senior clinicians, who had experienced with pessary used at each site, within one week of randomization.

Women allocated to progesterone group will be receiving 200 mg vaginal progesterone, purchased from the manufacturer (Cyclogest® 200 mg, Actavis, United Kingdom), once daily at bedtime. They will be given a monitoring sheet and instructed to note everyday the date of using.

In case of premature rupture of membranes, active vaginal bleeding, other signs of preterm labor or severe patient discomfort, the pessary may be removed. If participants develop (threatened) preterm labor, they will receive treatment per local protocol. Intervention will be stopped at 370/7 weeks of gestation or at delivery.

Along side with this trial, another study will be conducted to determine how changes in peripheral blood and cervical inflammatory markers are impacted by progesterone versus pessary. Because of that, participants will be asked to take 5 ml blood sample and cervical-vaginal discharge sampling at the time of randomization, 4-8 weeks after randomization and before giving birth.

A cost-effectiveness analysis will also be conducted alongside this RCT. Data will be reported in a separated paper.

Conditions

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Preterm Birth Short Cervix

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomised to either pessary or progesterone in a 1:1 ratio with a variable block size of 2, 4 or 6.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Cervical pessary

Cervical pessary (Arabin) will be inserted to participants at 16-22 weeks and removed at 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort.

Group Type ACTIVE_COMPARATOR

Cervical pessary

Intervention Type DEVICE

Arabin (cervical pessary) will be inserted at 16-22 weeks and removed at 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort

Vaginal Progesterone

Vaginal progesterone (Cyclogest 200 mg) once a day will be used, from 16-22 to 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort.

Group Type ACTIVE_COMPARATOR

Vaginal Progesterone

Intervention Type DRUG

Vaginal progesterone (Cyclogest 200 mg) once a day will be used, from 16-22 to 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort.

Interventions

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Cervical pessary

Arabin (cervical pessary) will be inserted at 16-22 weeks and removed at 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort

Intervention Type DEVICE

Vaginal Progesterone

Vaginal progesterone (Cyclogest 200 mg) once a day will be used, from 16-22 to 37 weeks of pregnancy or in case of premature rupture of membranes, signs of preterm labour or patient severe discomfort.

Intervention Type DRUG

Other Intervention Names

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Arabin Cyclogest 200 mg

Eligibility Criteria

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Inclusion Criteria

* Singleton pregnancies
* Cervical length ≤ 25 mm, measured by TVS at the second-trimester ultrasonography (16 0/7-22 0/7 weeks of gestation)
* Not participating in any other study which has intervention on maternity or fetus at the same time
* Provision of written informed consent to participate as shown by a signature on the patient consent form.

Exclusion Criteria

* Cervical dilation with visible amniotic membranes or amniotic membranes prolapsed into the vagina
* Major congenital abnormalities of the fetus
* Presence of severe vaginal discharge
* Presence of vaginitis or cervicitis
* Presence of vaginal bleeding
* Preterm premature rupture of membranes
* Premature labor without ruptured membrane at the time of screening
* Suspected chorioamnionitis
* Unable to have cervical pessary inserted
* Cerclage or pessary in place
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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My Duc Phu Nhuan Hospital HCMC, Vietnam

UNKNOWN

Sponsor Role collaborator

Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam

UNKNOWN

Sponsor Role collaborator

Mỹ Đức Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vinh Q Dang, MD

Role: PRINCIPAL_INVESTIGATOR

Mỹ Đức Hospital

Locations

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My Duc Phu Nhuan Hospital

Ho Chi Minh City, Phu Nhuan, Vietnam

Site Status RECRUITING

Mỹ Đức Hospital

Ho Chi Minh City, Tan Binh, Vietnam

Site Status RECRUITING

Quang Ninh Obstetrics and Pediatrics Hospital

Quang Ninh, , Vietnam

Site Status RECRUITING

Countries

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Vietnam

Central Contacts

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Vinh Q Dang, MD

Role: CONTACT

+84908225481

Minh N Chau, MD

Role: CONTACT

+84903119996

Facility Contacts

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Khang N Vu, MD

Role: primary

0983813006

Minh N Chau, MD

Role: primary

+84903119996

Long D Do, MD

Role: primary

0912388576

References

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Lawn JE, Kinney MV, Belizan JM, Mason EM, McDougall L, Larson J, Lackritz E, Friberg IK, Howson CP; Born Too Soon Preterm Birth Action Group. Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health. 2013;10 Suppl 1(Suppl 1):S6. doi: 10.1186/1742-4755-10-S1-S6. Epub 2013 Nov 15.

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Liem S, Schuit E, Hegeman M, Bais J, de Boer K, Bloemenkamp K, Brons J, Duvekot H, Bijvank BN, Franssen M, Gaugler I, de Graaf I, Oudijk M, Papatsonis D, Pernet P, Porath M, Scheepers L, Sikkema M, Sporken J, Visser H, van Wijngaarden W, Woiski M, van Pampus M, Mol BW, Bekedam D. Cervical pessaries for prevention of preterm birth in women with a multiple pregnancy (ProTWIN): a multicentre, open-label randomised controlled trial. Lancet. 2013 Oct 19;382(9901):1341-9. doi: 10.1016/S0140-6736(13)61408-7. Epub 2013 Aug 5.

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Other Identifiers

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CS/BVMD/20/04

Identifier Type: -

Identifier Source: org_study_id

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