Continuous Non-invasive Electrophysiological Monitoring in High Risk Pregnancies

NCT ID: NCT06151613

Last Updated: 2023-12-07

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

RECRUITING

Clinical Phase

NA

Total Enrollment

1911 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-22

Study Completion Date

2025-11-20

Brief Summary

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The goal of this single centre cohort intervention study with historical controls, is to investigate the effect of implementing continuous antepartum electrophysiological CTG (eCTG) monitoring at the Obstetric High Care (OHC), on perinatal and maternal outcomes and obstetric care.

The main aim is to investigate the effect of both monitoring methods on:

* primary outcome: perinatal outcomes (a composite of perinatal mortality or major neonatal morbidity) until hospital discharge
* secondary outcomes: Maternal mortality, neonatal morbidity, satisfaction for both patient and caregiver, duration of pregnancy, switch of monitoring method, duration of admission to the OHC, timing (planned or emergency) and number of obstetric interventions (such as caesarean section), and admission and duration of admission to the NICU (neonatal intensive care unit).

Eligible women will be prospectively included in the cohort receiving standard treatment: CTG monitoring intermittent up to three times a day. From these eligible women, a random sample (464) of the prospective cohort (511) will be offered to receive a new monitoring method: 24/7 eCTG monitoring. In order to strengthen the comparison between the two groups (eCTG and standard treatment), additional data from 1400 women who received standard treatment in 2014-2019 will be collected retrospectively.

Detailed Description

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Pregnant women in need for maternal and/or fetal monitoring are hospitalized at the obstetric high care (OHC) of Máxima Medical Center (MMC). They are monitored for up to three times a day with conventional cardiotocography (CTG). In the meantime they reside at the OHC, but the status of the fetus and uterine activity (UA) is not monitored. Nemo Healthcare developed a wireless abdominal electrode patch for measuring fetal heart rate (FHR) and UA: The Nemo Fetal Monitoring System (NFMS). Previous research on non-invasive electrophysiological CTG (eCTG) has yielded promising results in monitoring FHR and UA both during pregnancy and labor. With the use of eCTG technology, safe continuous 24/7 monitoring is possible, which is not possible with conventional cardiotocography. The investigators hypothesize that by introducing continuous antepartum eCTG monitoring perinatal and maternal outcomes will improve.

The investigators aim to include 1911 pregnant women ≥18 years old with a singleton pregnancy between 23+0 and 32+0 weeks of gestation requiring hospitalization on the OHC for maternal or fetal surveillance (including 1400 historical controls).

Additional objectives: The collected NFMS and demographic data will be used to develop and verify a mathematical model for the prediction of time until (preterm) birth, which may be used in clinical practice to reduce unnecessary OHC admissions and facilitate a better timing of interventions. Furthermore, data collected in this study (NFMS, accelerometric, annotated ultrasound) will be used for the development and verification of a mathematical model for the automated detection of fetal movements in NFMS data. This latter model might provide new opportunities in non-invasive monitoring of fetal health.

Conditions

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Perinatal Outcomes Preterm Birth High Risk Pregnancy

Keywords

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Electrophysiological monitoring Cardiotocography Antepartum monitoring continuous monitoring Non-invasive fetal monitoring

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

A single center prospective cohort intervention study with historical controls.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Continuous eCTG monitoring

For the continuous eCTG monitoring, a wireless abdominal electrode patch (measuring fetal heart rate (FHR) and uterine activity (UA)) is used, developed by Nemo Healthcare: The Nemo Fetal Monitoring System (NFMS).

The advantage of the NFMS is that is a safe method for continuous (24/7) fetal monitoring. Furthermore, the patch does not have to be repetitively repositioned during registration, it can be used under the shower and it is wireless giving women more freedom to move around freely. Another benefit of eCTG monitoring is that it is especially suited for women with obesity, where conventional CTG monitoring often fails

Group Type ACTIVE_COMPARATOR

continuous eCTG monitoring using the NFMS

Intervention Type DEVICE

Eligible women will be prospectively included in the cohort receiving standard treatment: CTG monitoring intermittent up to three times a day. From these eligible women, a random sample (464) of the prospective cohort (511) will be offered to receive a new monitoring method: 24/7 eCTG monitoring with NFMS. In order to strengthen the comparison between the two groups (eCTG and standard treatment), additional data from 1400 women who received standard treatment in 2014-2019 will be collected retrospectively.

Conventional intermittent CTG monitoring

Conventional intermittent CTG monitoring is performed in Maxima Medical Centre by the use of Philips Avalon FM 30 (Philips Healthcare, Eindhoven, The Netherlands).

This is a combined external measurement method using two transducers placed on the maternal abdomen: one to measure fetal heart rate (FHR) by the use of Doppler ultrasound (DU) and the other at the fundus of the uterus to measure uterine activity (UA) pattern (TOCO), keeping them in place with elastic banding.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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continuous eCTG monitoring using the NFMS

Eligible women will be prospectively included in the cohort receiving standard treatment: CTG monitoring intermittent up to three times a day. From these eligible women, a random sample (464) of the prospective cohort (511) will be offered to receive a new monitoring method: 24/7 eCTG monitoring with NFMS. In order to strengthen the comparison between the two groups (eCTG and standard treatment), additional data from 1400 women who received standard treatment in 2014-2019 will be collected retrospectively.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* ≥18 years old
* Singleton pregnancy ≥23+0 weeks of gestation
* Requiring hospitalization to the OHC for maternal or fetal surveillance (i.e. imminent preterm delivery(PPI), PE, HELLP, pregnancy induced hypertension (PIH), FGR, fetal distress, vaginal blood loss, fetal congenital anomalies)
* Parents wishing for fetal monitoring

Exclusion Criteria

* Multiple pregnancy
* Insufficient knowledge of Dutch or English language
* Contraindications to abdominal patch placement (dermatologic diseases of the abdomen precluding preparation of the abdomen with abrasive paper)
* Women connected to an external or implanted electrical stimulator (e.g. a pacemaker - exclusion due to possible signal interference)
* Fetal and/or maternal cardiac disease (i.e. arrhythmia, congenital defect)
* Treatment plan (with intervention planned within 24 hours after admission) already made before inclusion is completed
* Women admitted with a clinical diagnosis of sepsis with hypotension (i.e. septic shock).
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Maxima Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Nadine de Klerk

MD, researcher, PhD candidate

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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SG Oei, Prof.dr.

Role: PRINCIPAL_INVESTIGATOR

Maxima Medical Center

Locations

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Maxima Medical Centre

Veldhoven, North Brabant, Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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ND de Klerk, MD

Role: CONTACT

Phone: +40 8888384

Email: [email protected]

M. van der Ven, MD

Role: CONTACT

Phone: +31408888384

Email: [email protected]

Facility Contacts

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ND de Klerk, MD

Role: primary

Other Identifiers

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NL82869.015.22

Identifier Type: -

Identifier Source: org_study_id