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Bed Rest With a Short Cervix on Preterm Birth (BEWISE)

3. mai 2026 oppdatert av: Julie Glavind

BEWISE - Bed Rest With a Short Cervix on Preterm Birth

Maternal AR has long been used to prevent PTB. However, definitions of AR vary widely, ranging from complete bed rest to partial limitation of physical activity for one or more hours daily.

The use of maternal AR to prevent preterm birth is largely based on observational evidence linking strenuous physical activity to an increased risk of preterm birth, and the assumption that reduced activity may decrease myometrial activity. However, the existing evidence on the clinical effects of AR remains limited and has not demonstrated a reduction in preterm birth or a delay in deliv-ery. In contrast, some studies suggest a potential increase in preterm birth following AR and instead significant adverse maternal and fetal effects.

The overall aim of this study is to compare gestational age at birth in women with a short cervix who are prescribed AR compared with women with a short cervix who are not prescribed AR (NAR).

The primary hypothesis is that NAR is non-inferior to AR in prolonging pregnancy in women with a short cervix.

Secondary hypotheses are that, compared with AR, NAR is associated with higher level of physical activity, lower risk of maternal depression, and reduced risk of loss of maternal bone mineral density.

Through the BEWISE study, we wish to implement a change in the Danish national clinical practice regarding AR from recommending AR in risk groups (current practice) to no longer recommending AR as part as routine care (new practice). We will evaluate this change in clinical practice by prospectively collecting data from women both before and after implementation of the new recommendation. The transition from AR to NAR will be implemented sequentially in each Danish region using a randomised stepped-wedge (SW) cluster design, with each region constituting a cluster. The order in which regions transition is determined by randomisation. Each region will adopt the new recommendation at 3-month intervals, resulting in full national transition from AR to NAR within 12 months Eligible participants are pregnant women in gestational age 20+0 to 33+6 and cervical length < 25 mm in singleton pregnancies and < 30 mm in multiple pregnancies. Participants must be above 18 years of age and be able to read and understand Danish or English. There are no exclusion criteria.

The primary outcome is gestational age in days (continuous).

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Studietype

Intervensjonell

Registrering (Antatt)

6000

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Voksen
  • Eldre voksen

Tar imot friske frivillige

Nei

Beskrivelse

Pregnant women with gestational age 20+0 to 33+6

  • Cervical length < 25 mm in singleton pregnancies and < 30 mm in multiple pregnancies
  • Above 18 years of age
  • Reads and understands Danish or English

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Sekvensiell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: Activity Restriction
The comparison arm reflects current Danish clinical practice in each participating region. According to national recommendations, AR is indicated before GA 28+0, with the level of restriction determined by cervical length and clinical context. In singleton pregnancies with a cervix <10 mm in singleton/<15 mm in twins, strict AR is prescribed, defined as bed rest with only toilet allowance. In addition, thrombosis prophylaxis (Low Molecular Weight Heparin and compression stockings) is initiated in cases of strict AR. In women with a cervix of 10-14 mm in singletons/15-20 mm in twins, or in cases of PPROM with a cervix <25 mm, moderate AR is prescribed, defined as 2-8 hours of daily bed rest. The regimen is continued until 28 weeks of gestation.
Atferdsmessig: Activity Restriction
Recommendation to restrict physical activity in pregnant women with a short cervix. This may include increased rest or bed rest according to local clinical practice.
Andre navn:
  • AR
  • Bed Rest
Eksperimentell: No Activity Restriction

The intervention consists of a recommendation of NAR during pregnancy. No general or graded restrictions on daily activities are advised, and cervical length is not an indication for activity limitation, in line with current evidence.

The NAR recommendation is supported by a pragmatic clinical guidance. Women are advised to avoid activities that provoke pain, increase uterine contractions, or worsen pelvic pressure. Decisions regarding hospital admission or sick leave are based on individual clinical assessment rather than cervical length.

Specific advice may be provided when clinically indicated. Women are generally advised to avoid heavy weight-bearing exercise and lifting of objects exceeding approximately 10 kg. Otherwise, no specific restrictions on physical activity are imposed, provided that activities do not provoke symptoms such as pain, increased uterine contractions, or pelvic pressure. Sexual activity may be ad-dressed on an individual basis following clinical assessment.
Atferdsmessig: No Activity Restriction
Recommendation to continue normal daily activity in pregnant women with a short cervix, without restricting physical activity.
Andre navn:
  • Aktivitet
  • No Bed Rest
  • NAR

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Gestational age at birth
Tidsramme: At birth (from inclusion until delivery)
Gestational age at birth measured in completed days of pregnancy. This is calculated based on the estimated due date from ultrasound (crown-rump lenght <14weeks).
At birth (from inclusion until delivery)

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Birth before 37 weeks of gestation
Tidsramme: At birth
At birth
Gestational age at birth, pooled
Tidsramme: At birth (from inclusion until delivery)
  • 14+0-21+6 weeks
  • 22+0-27+6 weeks
  • 28+0-31+6 weeks
  • 32+0-36+6 weeks
  • Birth after 37+0 weeks of gestation
At birth (from inclusion until delivery)
Latency from inclusion to birth (days)
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
Onset of birth
Tidsramme: At birth (from inclusion until delivery)
  • Spontaneous
  • Induction
  • Caesarean section
At birth (from inclusion until delivery)
Mode of birth
Tidsramme: At birth (from inclusion until delivery)
  • Vaginal
  • Assisted vaginal
  • Planned caesarean section
  • Non planned caesarean section
At birth (from inclusion until delivery)
- Non-occipital presentation
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
Interventions during birth
Tidsramme: At birth (from inclusion until delivery)
  • Oxytocin-infusion
  • Epidural anaesthesia
At birth (from inclusion until delivery)
Degree of birth tear
Tidsramme: At birth (from inclusion until delivery)
  • No tear
  • 1. or 2. degree tear
  • 3. or 4. degree tear
At birth (from inclusion until delivery)
Maternal serious morbidity
Tidsramme: From inclusion to 42 days after delivery
Admission to an intensive care unit or a unit providing 24-hour medical supervision, mechanical ventilation, or continuous vasoactive drug support at any time during pregnancy and postpartum due to pregnancy- or childbirth-related complications
From inclusion to 42 days after delivery
Umbilical cord arterial pH
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
EPDS depression score
Tidsramme: From inclusion to 8 weeks after due date
From inclusion to 8 weeks after due date
Bone turnover marker level
Tidsramme: At inclusion and after 4 and 8 weeks.
  • Procollagen type 1 N-propeptide (PINP)
  • Carboxy-terminal telopeptide of type I collagen (CTX)
At inclusion and after 4 and 8 weeks.
Lumbar spine Z-score
Tidsramme: 12 months after stopped breastfeeding
12 months after stopped breastfeeding
Data from SENS activity tracker
Tidsramme: At birth (from inclusion until delivery)
Step count Time in supine position
At birth (from inclusion until delivery)
Neonatal mortality
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
Fetal loss
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
Birth weight
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)
Neonatal admission, days
Tidsramme: From inclusion until discharge or 44 postmenstrual weeks
From inclusion until discharge or 44 postmenstrual weeks
CNS morbidity
Tidsramme: From inclusion until discharge or 44 postmenstrual weeks
Intraventricular haemorrhage grade III or IV, Periventricular leukomalacia
From inclusion until discharge or 44 postmenstrual weeks
Gastrointestinal morbidity
Tidsramme: From inclusion until discharge or 44 postmenstrual weeks
Necrotizing enterocolitis (NEC) requiring surgery (Bell's stage 3), Spontaneous intestinal perfo-ration (SIP) requiring surgical treatment
From inclusion until discharge or 44 postmenstrual weeks
Respiratory support
Tidsramme: From inclusion until discharge or 44 postmenstrual weeks
Mechanical ventilation or non-invasive ventilation (NIV)
From inclusion until discharge or 44 postmenstrual weeks
Respiratory distress syndrome (RDS)
Tidsramme: From inclusion until discharge or 44 postmenstrual weeks
From inclusion until discharge or 44 postmenstrual weeks
Early onset infection
Tidsramme: From inclusion to 5 days after birth
Definition: >5 days of i.v. antibiotics where the treatment starts within the first week after delivery.
From inclusion to 5 days after birth
Apgar score at 5 minutes
Tidsramme: At birth (from inclusion until delivery)
At birth (from inclusion until delivery)

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Julie Glavind

Samarbeidspartnere

Odense University Hospital
Zealand University Hospital
Aarhus University Hospital
Rigshospitalet, Denmark
Aalborg University Hospital
University of Aberdeen

Etterforskere

  • Hovedetterforsker: Julie Glavind, Senior Consultant, MD, PhD, Aarhus Univeristy Hospital, Department of Obstetrics and Gynecology

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Antatt)

1. mai 2026

Primær fullføring (Antatt)

1. februar 2029

Studiet fullført (Antatt)

1. mai 2029

Datoer for studieregistrering

Først innsendt

3. mai 2026

Først innsendt som oppfylte QC-kriteriene

3. mai 2026

Først lagt ut (Faktiske)

11. mai 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

11. mai 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

3. mai 2026

Sist bekreftet

1. mai 2026

Mer informasjon

Begreper knyttet til denne studien

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 16-0500-15
  • 4308-00216B (Annet stipend/finansieringsnummer: Independent Research Fund Denmark)
  • 1-10-72-96-25 (Annen identifikator: De Videnskabsetiske Komitéer For Region Midtjylland)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

UBESLUTTE

IPD-planbeskrivelse

IPD will be shared if possible according to GDPR and Danish legislation

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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