- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03106753
Success of External Cephalic Version Study
September 15, 2020 updated by: Natalie Porat, Icahn School of Medicine at Mount Sinai
Success of External Cephalic Version With Immediate Spinal Anesthesia Versus Spinal Anesthesia When Attempt Without Anesthesia Has Failed: A Randomized Controlled Trial
The purpose of this study is to determine the best way to optimize the success of external cephalic version (turning the baby from the outside).
Attempting to turn babies in-utero is recommended because it may decrease the risk of needing a cesarean section for abnormal presentation.
While the study team knows that this procedure can be effective, the study team still has some un-answered questions as to the best way to perform this procedure to increase the chance of success.
Many prior studies have shown that using spinal anesthesia (a shot of medication placed in your back to numb and relax the abdomen) can increase the success rate of a version.
This ultimately has led to the finding that using this anesthesia can decrease the rate of cesarean section.
However, there have been only a small number of studies assessing the success rate if spinal anesthesia is used only in the event that without it fails.
Therefore the study team is going to compare patients who receive spinal anesthesia with those who only receive spinal anesthesia if the procedure to turn the baby (ECV) fails without it.
Study Overview
Status
Terminated
Conditions
Intervention / Treatment
Detailed Description
Breech presentation occurs in approximately 3-4% of term pregnancies and leads to one of the most common indications for cesarean delivery.
Attempting an external cephalic version (ECV) significantly increases the chance of cephalic presentation at time of delivery and reduces the chance of cesarean section.
Since ECV does in fact reduce the rate of cesarean section, many studies have sought to determine the best method to perform the procedure to optimize the chance of success.
A recent meta-analysis concluded that administration of neuraxial analgesia significantly increases the success rate of ECV and also increases the incidence of vaginal delivery.
However, there have been only 2 prospective studies and no randomized trials that evaluated the success of ECV using neuraxial analgesia only when initial attempt without it has failed.
Therefore, the study team designed a randomized controlled trial with two groups: Group 1- patients receiving spinal anesthesia immediately versus Group 2- patients attempting ECV without spinal anesthesia with reattempt using a spinal if first attempt fails.
This study will be conducted on labor and delivery at Mount Sinai West hospital.
Patients who present to labor and delivery at term for ECV will be approached for enrollment and those who consent to be part of the study would be randomized into a group.
ECV will then be attempted and delivery and neonatal outcomes will be collected.
Patients will likely be enrolled in the study from time of version (approximately 37 weeks) until postpartum.
This study will take approximately 1-2 years given the ECV rate.
Study Type
Interventional
Enrollment (Actual)
34
Phase
- Phase 4
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
-
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New York
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New York, New York, United States, 10019
- Mount Sinai West
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-
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
18 years to 60 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Description
Inclusion Criteria:
- Patients included are those with singleton pregnancies of at least 37 weeks gestation in nonvertex presentation with no contraindication for a vaginal delivery.
- Membranes must be intact with a minimum of a 2x2 pocket and Category 1 non-stress test.
Exclusion Criteria:
- All patients with a contraindication for a vaginal delivery will be excluded from the study.
- Patients with gross fetal anomalies or uterine malformations.
- Patients with contraindications to neuraxial anesthesia or allergies to any of the study medications will also be excluded.
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: Spinal anesthesia immediately for ECV.
The patient will have a spinal administered by the on call anesthesiologist using standard protocol (intrathecal bupivacaine 7.5 mg).
The patient will then be administered 0.25 mg Terbutaline subcutaneously and the ECV will be attempted.
Under ultrasound guidance the provider will attempt to lift the breech upward from the pelvis with one hand and guide the head with the other hand to produce a forward roll.
If forward roll fails, a backward roll somersault may be attempted.
ECV attempt will be abandoned if there is significant fetal bradycardia, discomfort to the patient, or if the procedure cannot be completed easily with these maneuvers.
Once attempt is complete, whether successful or not, the patient will be monitored for a minimum of 30 minutes, and will be discharged once they are able to walk, void, and tolerate PO intake, only if fetal and maternal status is reassuring.
|
intrathecal bupivacaine 7.5 mg
0.25 mg Terbutaline subcutaneously
|
Experimental: Spinal anesthesia if no intervention fails for ECV.
The patient will be administered terbutaline 0.25 mg subcutaneously and the version will be attempted using the same procedure as above.
If successful, the patient will be monitored for 30 minutes and discharged if fetal and maternal status is reassuring.
If the attempt fails, the patient will be administered spinal anesthesia as above and the same maneuvers will be attempted.
Once attempt is complete, whether successful or not, the patient will be monitored for a minimum of 30 minutes, and will be discharged once they are able to walk, void, and tolerate PO intake, only if fetal and maternal status is reassuring.
|
intrathecal bupivacaine 7.5 mg
0.25 mg Terbutaline subcutaneously
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Success Rate of External Cephalic Version to Cephalic Presentation.
Time Frame: Day 1
|
Success rate will be measured by comparing the percentage of successful external cephalic versions in each group.
|
Day 1
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time From Procedure to Delivery.
Time Frame: up to day 42
|
Number of days from procedure to delivery.
|
up to day 42
|
Number of Participants With Various Mode of Delivery
Time Frame: up to day 42
|
Mode of delivery as incidence of spontaneous vaginal delivery, operative vaginal delivery, or cesarean section.
|
up to day 42
|
Numeric Rating Scale (NRS-11)
Time Frame: Day 1
|
Patient discomfort rated with NRS-11.
Total scale from 0-10, with higher score indicating more pain.
|
Day 1
|
Number of Adverse Events During Procedure
Time Frame: Day 1
|
Number of total specific adverse events such as: fetal bradycardia, emergent cesarean section, or abruption.
|
Day 1
|
Newborn Birth Weight
Time Frame: Day 1 of delivery
|
Newborn birth weight in grams.
|
Day 1 of delivery
|
Number of Participants With Newborns With Apgar Score 7 or 9
Time Frame: 7 minutes and 9 minutes after delivery
|
Newborns with Apgar Score 7 or 9 at 5 minutes after delivery.
The Apgar score is based on a total score of 1 to 10.
The higher the score, the better the baby is doing after birth.
A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.
|
7 minutes and 9 minutes after delivery
|
Cord pH
Time Frame: Day 1
|
Arterial cord pH level
|
Day 1
|
Number of NICU Admission
Time Frame: Day 1
|
Number of patients whose neonate was admitted to the NICU in each group.
|
Day 1
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Natalie Porat, MD, Icahn School of Medicine at Mount Sinai
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Hofmeyr GJ, Kulier R, West HM. External cephalic version for breech presentation at term. Cochrane Database Syst Rev. 2015 Apr 1;2015(4):CD000083. doi: 10.1002/14651858.CD000083.pub3.
- Magro-Malosso ER, Saccone G, Di Tommaso M, Mele M, Berghella V. Neuraxial analgesia to increase the success rate of external cephalic version: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2016 Sep;215(3):276-86. doi: 10.1016/j.ajog.2016.04.036. Epub 2016 Apr 27. Erratum In: Am J Obstet Gynecol. 2017 Mar;216(3):315.
- Neiger R, Hennessy MD, Patel M. Reattempting failed external cephalic version under epidural anesthesia. Am J Obstet Gynecol. 1998 Nov;179(5):1136-9. doi: 10.1016/s0002-9378(98)70120-6.
- Rozenberg P, Goffinet F, de Spirlet M, Durand-Zaleski I, Blanie P, Fisher C, Lang AC, Nisand I. External cephalic version with epidural anaesthesia after failure of a first trial with beta-mimetics. BJOG. 2000 Mar;107(3):406-10. doi: 10.1111/j.1471-0528.2000.tb13238.x.
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)
April 12, 2017
Primary Completion (Actual)
May 5, 2018
Study Completion (Actual)
May 5, 2018
Study Registration Dates
First Submitted
March 27, 2017
First Submitted That Met QC Criteria
April 7, 2017
First Posted (Actual)
April 10, 2017
Study Record Updates
Last Update Posted (Actual)
October 9, 2020
Last Update Submitted That Met QC Criteria
September 15, 2020
Last Verified
September 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Autonomic Agents
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Adrenergic Agonists
- Anesthetics, Local
- Bronchodilator Agents
- Anti-Asthmatic Agents
- Respiratory System Agents
- Reproductive Control Agents
- Adrenergic beta-2 Receptor Agonists
- Adrenergic beta-Agonists
- Tocolytic Agents
- Sympathomimetics
- Bupivacaine
- Terbutaline
Other Study ID Numbers
- GCO 17-0236
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
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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