What After the First Propess (PRODUCT)

November 9, 2022 updated by: Amr Farag, South Warwickshire NHS Foundation Trust

What After the First Propess. A Randomised Comparative Prospective Study

The aim of this study is to compare three different regimens for continuation of induction of labor after no spontaneous or artificial rupture of membranes could be achieved after first 24 hours post-insertion of Dinoprostone

Study Overview

Detailed Description

This randomized study will be carried out at delivery suite in Warwick Hospital after eligible women have been informed of the study when booked for induction of labor and provided with the study information leaflet

When attending for induction of labor on delivery suite, an informed consent will be obtained then all women will have a cardiotocogram (CTG) performed initially and will be assessed by vaginal examination and Bishop score recorded at insertion of first slow-release pessary (Propess®10 mg Dinoprostone; CTS, UK), which will be inserted high into the posterior vaginal fornix. Assessment and insertion of pessary will be done by an experienced obstetrician or a senior midwife

All women will be given the required care and support as per the local protocols and guidelines

Women will be excluded from the study within the first 24 hours of induction of labor in the following conditions:

  • Women with abnormal or non-reassuring CTG needing intervention.
  • Women needing tocolytic use.
  • Women needing removal of the Dinoprostone pessary.
  • Women needing emergency Caesarean section.
  • If spontaneous rupture of membranes occurs.
  • If artificial rupture of membranes is achievable after the first 24 hours of induction of labor (Bishop score 5 or more)
  • If woman withdraws her consent to continue as a part of the study.

After 24 hours from insertion of the first Dinoprostone pessary, women will be reassessed and a total of 330 women with Bishop score less than 7, will be randomly assigned to one of three intervention groups by a pre-formed computer-generated random list and randomization put in sealed opaque envelopes kept in a locked secure area on delivery suite.

Intervention groups will be as follows:

Group 1 (110 women):

Women will have the initial slow-release Dinoprostone pessary left in place for six more hours (total of 30 hours in place) then removed followed by vaginal assessment 48 hours after the start of labour induction and insertion of a second slow-release pessary if required (Currently Propess® is not licensed to be repeated as a second dose. However, there is a consensus that, the dose may be repeated after a consultant review and an informed verbal consent as per SWH 00190 Induction and Augmentation of the First and Second Stage of Labour Management Guideline, 2012).

Group 2 (110 women):

Women will have the initial slow-release Dinoprostone pessary removed followed by insertion of quick-release Dinoprostone tablet (Prostin® 3 mg Dinoprostone vaginal tablet; Pfizer, UK) high in the posterior vaginal fornix immediately after removal of the slow-release pessary. The tablet will be left for 6 hours followed by vaginal reassessment and insertion of a second tablet if ARM is still not achievable.

Group 3 (110 women):

Women will have the initial slow-release Dinoprostone pessary removed followed by insertion of 1-5 Osmotic cervical rods (Dilapan-S® Aquacryl hydrogel rod; HPSRx Enterprises, USA) by a senior obstetrician or a midwife into the cervical canal, immediately after removal of the slow-release pessary using a vaginal speculum and a holder. The rods will be left for 12-24 hours.

For all participants, after achieving spontaneous or artificial rupture of membranes, the local protocol for intrapartum care will be followed and after delivery, the women will be asked to fill in a patient's satisfaction questionnaire about the process of induction, care given and being a part of the study

Study Type

Interventional

Enrollment (Actual)

85

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

      • Walsall, United Kingdom, WS2 9PS
        • Walsall Healthcare NHS Trust

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Women booked for induction of labor at 37 to 42 weeks gestation
  • Viable singleton pregnancy.
  • Cephalic presentation.
  • Intact membranes.
  • No previous Caesarean section.
  • No antenatal fetal concerns (Fetal growth restriction (FGR), small for gestational age (SGA), impaired Doppler, oligohydramnios, non-reassuring/abnormal CTG).

Exclusion Criteria:

  • Pregnancy less than completed 37 weeks or more than 42 weeks.
  • Multiple pregnancy.
  • Intrauterine fetal death.
  • Non-cephalic presentation.
  • Pre-labor rupture of membranes
  • Previous one or more Caesarean sections.
  • Antenatal concerns regarding fetal well-being (FGR, SGA, impaired Doppler, oligohydramnios, non-reassuring/abnormal CTG).
  • Non-reassuring or abnormal CTG on admission to labor ward

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

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
Active Comparator: Extension of propess+/-second propess
Women will have the initial slow-release Dinoprostone pessary left in place for six more hours (total of 30 hours in place) then removed followed by vaginal assessment 48 hours after the start of labour induction and insertion of a second slow-release pessary if required
Other Names:
  • Propess
Active Comparator: Prostin
Women will have the initial slow-release Dinoprostone pessary removed followed by insertion of quick-release Dinoprostone tablet (Prostin® 3 mg Dinoprostone vaginal tablet; Pfizer, UK) high in the posterior vaginal fornix immediately after removal of the slow-release pessary. The tablet will be left for 6 hours followed by vaginal reassessment and insertion of a second tablet if ARM is still not achievable.
Other Names:
  • Prostin
Active Comparator: Dilapan-S
Women will have the initial slow-release Dinoprostone pessary removed followed by insertion of 1-5 Osmotic cervical rods (Dilapan-S® Aquacryl hydrogel rod; HPSRx Enterprises, USA) by a senior obstetrician or a midwife into the cervical canal, immediately after removal of the slow-release pessary using a vaginal speculum and a holder. The rods will be left for 12-24 hours.
Other Names:
  • Dilapan-S

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Rate of achieving spontaneous or artificial rupture of membranes
Time Frame: 12 months
percentage of women who will have spontaneous or artificial rupture of membranes
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time interval needed from start of induction of labor to achieve spontaneous or artificial rupture of membranes
Time Frame: 12 months

The time frame is 6 months from the onset of the study till assessing the results, doing the analysis and presenting.

But, the time interval stated as an outcome here is the period of time elapsing from starting induction of labour and rupturing the membranes whether spontaneous or artificial

12 months
Rate of hyperstimulation (contractions more than 5 in 10 minutes or each contraction lasting more than 90 seconds)
Time Frame: 12 months
percentage of women who will develop uterine hyperstimulation
12 months
Rate of abnormal CTG changes needing intervention
Time Frame: 12 months
percentage of women with non-reassuring or abnormal CTG that need intervention
12 months
Rate of need for tocolysis
Time Frame: 12 months
percentage of women who need tocolysis to treat hyperstimulation
12 months
Rate of emergency Caesarean section
Time Frame: 12 months
percentage of women who need Caesarean section for fetal distress or failed induction/progress of labour
12 months
Grades of Caesarean sections
Time Frame: 12 months
percentage of each of grade 1,2 and 3 Caesarean sections among each group
12 months
Women's satisfaction with the method of induction used
Time Frame: 12 months
scoring system based on women's questionnaire formed of 3 questions with a score of 3 to 15. In addition, evaluation of pain score out of 10
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Amr H Farag, Consultant, Walsall Healthcare NHS Trust

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2017

Primary Completion (Actual)

November 1, 2022

Study Completion (Actual)

November 1, 2022

Study Registration Dates

First Submitted

October 29, 2016

First Submitted That Met QC Criteria

November 3, 2016

First Posted (Estimate)

November 6, 2016

Study Record Updates

Last Update Posted (Actual)

November 14, 2022

Last Update Submitted That Met QC Criteria

November 9, 2022

Last Verified

November 1, 2022

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 202984

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.

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