- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02684305
Stepwise Labor Induction Following Failure of Prostaglandin Vaginal Insert for Labor Induction
Induction of labor is one of the most common obstetrical medical procedures performed today. Iatrogenic stimulation of uterine contractions prior to the onset of spontaneous labor is undertaken for various maternal and fetal indications and spans 20% of deliveries today.
- During the past years there has been an additional rise due to elective inductions
- Induction is undertaken when potential risks of prolonging pregnancy outweigh the risks of induced delivery, particularly those associated with post-term pregnancy, rupture of membranes, oligohydramnios and additional fetal and maternal conditions that pose risks to mother and fetus.
In many circumstances of women with an unfavorable cervix (Bishop score of 7 or less) sequential induction with more than one agent is necessary. To date, no trial has compared the optimal subsequent ripening method after the preliminary use of dinoprostone (prostaglandin E2). In this trial investigators aim to compare the obstetrical outcomes of subsequent induction in women admitted for induction of labor with Bishop score <7 or less 24 hours after the insertion of vaginal prostaglandin insert (Propess). Two methods of routine induction of labor will be compared: An additional Propess induction for another 24 hours vs. intravenous oxytocin infusion combined with intra-cervical balloon insertion.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Induction of labor is one of the most common obstetrical medical procedures performed today. Iatrogenic stimulation of uterine contractions prior to the onset of spontaneous labor is undertaken for various maternal and fetal indications and spans 20% of deliveries today
- During the past years there has been an additional rise due to elective inductions
- Induction is undertaken when potential risks of prolonging pregnancy outweigh the risks of induced delivery, particularly those associated with post-term pregnancy, rupture of membranes, oligohydramnios and additional fetal and maternal conditions that pose risks to mother and fetus.
In many circumstances of women with an unfavorable cervix (Bishop score of 7 or less) sequential induction with more than one agent is necessary. To date, no trial has compared the optimal subsequent ripening method after the preliminary use of dinoprostone (prostaglandin E2). In this trial investigators aim to compare the obstetrical outcomes of subsequent induction in women admitted for induction of labor with Bishop score <7 or less 24 hours after the insertion of vaginal prostaglandin insert (Propess). Two methods of routine induction of labor will be compared: An additional Propess induction for another 24 hours vs. intravenous oxytocin infusion combined with intra-cervical balloon insertion.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: yariv yogev, professor
- Phone Number: 97236925603
- Email: yarivy@tlvmc.gov.il
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Maternal age of 18 years or greater
- Singleton gestation
- Bishop score of 7 or less 24 hours after the insertion of Propess
- Pregnancies at 36+0/7 weeks of gestation and beyond
- Normal fetal heart rate tracings and normal sonogram at admission (ie Vertex, appropriate for gestational age, biophysical score of 8/8, normal amniotic fluid index)
- No contraindication for prolongation of pregnancy (e.g. intrauterine infection, placental abruption, etc.)
Exclusion Criteria:
- Situations preventing continuation of induction process in any arm - patient refusal, maternal of fetal conditions necessitating prompt delivery.
- Rupture of membranes (ROM) after initial Propess insertion.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Administration of Propess
All women who failed induction of labor using vaginal insert slow release of dinoprostone 10 mg (Propess), defined as bishop score ≤ 7 24 hours after propess insertion will be randomized to one of the following treatment arms: 1.Administration of Propess for additional 24 hours. |
Follow up on all women will be performed from the time of second agent induction until discharge from hospital postpartum. |
Experimental: Intravenous oxytocin infusion + balloon
All women who failed induction of labor using vaginal insert slow release of dinoprostone 10 mg (Propess), defined as bishop score ≤ 7 24 hours after propess insertion will be randomized to one of the following treatment arms: 2. Intravenous oxytocin infusion combined with intracervical balloon administration, inflated with 60cc of saline. |
Follow up on all women will be performed from the time of second agent induction until discharge from hospital postpartum.
Follow up on all women will be performed from the time of second agent induction until discharge from hospital postpartum. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time from second agent induction to delivery
Time Frame: 48 hours
|
Time from second agent induction to active labor
|
48 hours
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of failed induction defined as 5 cm dilatation
Time Frame: 48 hours
|
Defined as 5 cm dilatation with regular contractions
|
48 hours
|
Rate of failed induction defined as regular contractions
Time Frame: 48 hours
|
Rate of failed induction defined as regular contractions (over 3 contractions in 30 min)
|
48 hours
|
cesarean sections rate
Time Frame: 48 hours
|
Number of cesarean sections rate due to tachysystole and non-reassuring fetal heart rate.
|
48 hours
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 686-15- TLV
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Induction of Labor
-
Rambam Health Care CampusNot yet recruitingInduction of Labor
-
Duke UniversityCompleted
-
Ochsner Health SystemNorthwell HealthTerminatedInduction of LaborUnited States
-
Brigham and Women's HospitalCompleted
-
Aultman Health FoundationCompletedInduction of LaborUnited States
-
Dina Yahia MansourUnknown
-
HaEmek Medical Center, IsraelCompletedSingle Balloon Catheter Compared With Double Balloon Catheter for Ripening of the Unfavorable CervixInduction of LaborIsrael
-
Holy Family Hospital, Nazareth, IsraelRecruitingInduction of LaborIsrael
-
Kazakhstan's Medical University "KSPH"Asfendiyarov Kazakh National Medical UniversityActive, not recruitingInduction of LaborKazakhstan
-
Sorlandet Hospital HFOstfold Hospital Trust; Haukeland University Hospital; St. Olavs Hospital; Nordlandssykehuset...Completed
Clinical Trials on Administration of Propess
-
Ferring PharmaceuticalsCompleted
-
Seoul National University HospitalCompletedInduction of LaborKorea, Republic of
-
Hanoi Obstetrics and Gynecology HospitalMỹ Đức HospitalRecruitingInduction of LaborVietnam
-
University Medical Centre LjubljanaNot yet recruitingPrelabor Rupture of Membranes
-
Zeynep Kamil Maternity and Pediatric Research and...CompletedUnfavorable Cervix, Cervical RipeningTurkey
-
Ferring PharmaceuticalsCompleted
-
Erzincan Military HospitalCompletedLabor | Induction | PROM (Pregnancy)Turkey
-
Ferring PharmaceuticalsCompleted
-
Liverpool Women's NHS Foundation TrustUniversity of LiverpoolCompletedPregnancy | Intrapartum Fetal MonitoringUnited Kingdom
-
University Hospital, MontpellierCompleted