- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04362592
In-Utero Endoscopic Correction of Spina Bifida
June 12, 2023 updated by: Ramen Chmait, University of Southern California
In-Utero Endoscopic Correction of Spina Bifida: Laparotomy-Assisted or Percutaneous
The purpose of this study is to evaluate the feasibility and effectiveness of performing fetoscopic surgical correction of fetal spina bifida.
Two surgical approaches will be utilized: the percutaneous technique versus the laparotomy/uterine exteriorization technique.
Study Overview
Status
Recruiting
Conditions
Study Type
Interventional
Enrollment (Estimated)
110
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Ruben Quintero, MD
- Phone Number: 720-753-3825
- Email: q@the-fetal-institute.com
Study Contact Backup
- Name: Ramen Chmait, MD
- Phone Number: 213-469-6277
- Email: chmait@usc.edu
Study Locations
-
-
California
-
Los Angeles, California, United States, 90027
- Recruiting
- Hollywood Presbyterian Medical Center
-
Contact:
- Ramen Chmait, MD
- Phone Number: 213-469-6277
- Email: chmait@usc.edu
-
Contact:
- Arlyn Llanes, RN
- Phone Number: 213-469-6277
- Email: arlyn.llanes@med.usc.edu
-
-
Florida
-
Wellington, Florida, United States, 33141
- Recruiting
- Wellington Regional Medical Center
-
Contact:
- Ruben Quintero, MD
- Phone Number: 720-753-3825
-
Contact:
- Eftichia Kontopoulos, MD
- Phone Number: 720-753-3825
-
-
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 52 years (Adult)
Accepts Healthy Volunteers
Yes
Description
Inclusion Criteria:
- Myelomeningocele (including myeloschisis) at level T1 through S1 with hindbrain herniation. Lesion level and hindbrain herniation will be confirmed by MRI and ultrasonography.
- Maternal age ≥18 years.
- Gestational age of 19 to 27 6/7 weeks' gestation as determined by clinical information and evaluation of first ultrasound.
- Balanced karyotype and/or normal mircoarray with written confirmation of culture results. Results by fluorescence in situ hybridization (FISH) will be acceptable if the patient is at 24 weeks or more.
- Positive evaluation of social work consult indicating the patient is capable of consenting to the procedure and has the appropriate social support system to participate in the study.
- Positive evaluation from pediatric neurology consult.
- Willing to return to our center, or to a multi-disciplinary spina bifida clinic closer to their home for the 6, 12, 24, 30, 48, and 60 months follow-up evaluations.
Exclusion Criteria:
- Multiple gestation
- Insulin-dependent pregestational diabetes
- Presence of a fetal anomaly not related to Chiari II Malformation. A fetal echocardiogram will be conducted before surgery and if the finding is abnormal, the patient will be excluded.
- Fetal kyphosis of 30 degrees or more, assessed by ultrasound or MRI.
- Presence of uterine cervical cerclage or history of incompetent cervix.
- Placenta previa or placental abruption.
- Short cervix < 25 mm measured by cervical ultrasound.
- Obesity as defined by body mass index (BMI) of 40 or greater.
- History of previous spontaneous singleton delivery prior to 37 weeks.
- Maternal-fetal Rh isoimmunization, Kell sensitization or a history of neonatal alloimmune thrombocytopenia.
- Maternal HIV or Hepatitis-B status positive because of the increased risk of transmission to the fetus during maternal-fetal surgery. If the patient's HIV or Hepatitis B status is unknown, the patient must be tested and found to have negative results before she can be enrolled.
- Known Hepatitis-C positivity. If the patient's Hepatitis C status is unknown, she does not need to be screened.
- Uterine anomaly such as large (greater than 6 cm) fibroids, cervical fibroids or multiple fibroids or Mullerian duct abnormality.
- Other maternal medical condition which is a contraindication to surgery or anesthesia.
- Patient does not have a support person (e.g., husband, partner, parents).
- Inability to comply with the travel and follow-up requirements of the study.
- Patient does not meet psychosocial criteria as determined by the social worker evaluation.
- Participation in another intervention study that influences maternal and fetal morbidity and mortality.
- Maternal hypertension as determined by the investigator, which would increase the risk of preeclampsia or preterm delivery (including, but not limited to: uncontrolled hypertension, chronic hypertension with end organ damage and new onset hypertension in current pregnancy).
- Bicornuate uterus or any other uterine malformation the PI decides is not safe for surgery.
- Nickel allergy.
- Maternal request to undergo open fetal surgery for the antenatal correction of OSB at our institution primarily or after failed fetoscopic approach.
- Known maternal hypersensitivity to bovine collagen or chondroitin materials.
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: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Laparotomy/Uterine Exteriorization Technique
The laparotomy/uterine exteriorization technique consists of performing a laparotomy (incision into the abdominal cavity), exteriorizing the uterus, and using endoscopic scopes through the uterus to perform the correction.
|
The laparotomy/uterine exteriorization technique uses endoscopes through an open abdomen and closed, exteriorized uterus to perform the spina bifida correction.
|
Experimental: Percutaneous Technique
The percutaneous technique uses endoscopic scopes through the maternal skin and uterus to perform the surgery.
A variation of the percutaneous technique is the mini-laparotomy technique, which uses an endoscopic scope through an incision on the abdomen, smaller than a laparotomy ("mini-laparotomy"), and smaller endoscopic scopes through the maternal skin and uterus to perform the surgery.
|
The percutaneous approach uses endoscopes through a closed maternal abdomen and closed uterus to perform the spina bifida correction.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ability to perform the endoscopic procedure
Time Frame: At time of surgery
|
Successful fetoscopic closure of the defect
|
At time of surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Chiari II malformation reversal
Time Frame: Prior to delivery
|
Reversal of hindbrain herniation on ultrasound and MRI
|
Prior to delivery
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Ramen Chmait, MD, University of Southern California
- Principal Investigator: Ruben Quintero, MD, US Fetus
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)
November 2, 2018
Primary Completion (Estimated)
June 1, 2026
Study Completion (Estimated)
October 31, 2031
Study Registration Dates
First Submitted
March 24, 2020
First Submitted That Met QC Criteria
April 22, 2020
First Posted (Actual)
April 27, 2020
Study Record Updates
Last Update Posted (Actual)
June 15, 2023
Last Update Submitted That Met QC Criteria
June 12, 2023
Last Verified
June 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HS-05-00374
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
Yes
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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