STV-analys kontra visuell utvärdering av kardiotokografi i FGR (SAVEFGR)
Kortsiktig variationsanalys kontra visuell utvärdering av kardiotokografi vid fostertillväxtrestriktion
This stepped wedge cluster randomized clinical trial investigates whether in pregnant women with severe, early-onset fetal growth restriction, the use of STV analysis in fetal monitoring improves the chances of perinatal survival, compared with visual evaluation of the cardiotocography.
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Severe, early-onset fetal growth restriction (FGR, <32 weeks gestation) is a condition in which the fetus does not reach its growth potential due to placental insufficiency[. This condition affects about 0.3% of pregnancies, accounting for an estimated 15,000 babies in Europe being born premature below 32 weeks gestation. The main clinical dilemma of FGR lies in the timing of birth, given the balance of risks of antenatal mortality and severe damage to organs and the aggravated neonatal effects of prematurity: death or survival with severe neurodevelopmental impairment. The mainstay of clinical management in these cases pivots around the anticipation of the risk of fetal demise from placental oxygenation failure. The monitoring variables that are currently available comprise assessment of the severity of metabolic insufficiency (fetal size and growth, Doppler ultrasound, serum biomarkers) and the early detection of progressive fetal hypoxia with cardiotocography (CTG). The common approach is to deliver the fetus when signs of advanced hypoxia appear on CTG. A delicate balance exists between having the fetus born (too) early and facing the risks of extreme prematurity combined with a very low birthweight; and between delivering the fetus (too) late when the fetus has the disadvantage of hypoxia at birth. The decision when to deliver the fetus, is made mostly based on the CTG. The inter- and intra-observer variability could be overcome by software analysis according to the original Dawes&Redman algorithm. The software calculates the short-term variation (STV) of the inter-beat interval expressed in milliseconds, and a range of secondary calculations. In contrast with repeated decelerations, when fetal hypoxia is considered evident, the place of the software analysis of the fetal heart rate variability is less clear. Although the advantages of mathematized and uniform quantification of the fetal heart rate variability appear self-evident, there are no studies with sufficient power to detect an association of intervention based on STV at any threshold with the most important outcomes: fetal death and long-term infant outcome.
The purpose of this study is to assess the outcomes of monitoring the fetal condition with STV in computerized CTG compared to visual interpretation of the CTG in order to time delivery in pregnant women with severe, early-onset FGR.
Studietyp
Inskrivning (Beräknad)
Fas
- Inte tillämpbar
Kontakter och platser
Studiekontakt
- Namn: Wessel Ganzevoort, MD PhD
- Telefonnummer: 003120-5669111
- E-post: j.w.ganzevoort@amsterdamumc.nl
Studera Kontakt Backup
- Namn: Anouk Pels, MD PhD
- Telefonnummer: 003120-5669111
- E-post: a.pels@amsterdamumc.nl
Studieorter
-
-
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Amsterdam, Nederländerna
- Har inte rekryterat ännu
- Amsterdam University Medical Center
-
Kontakt:
- M. E. Bruins
- Telefonnummer: +3120 566 9111
- E-post: m.e.bruins@amsterdamumc.nl
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Maastricht, Nederländerna
- Har inte rekryterat ännu
- Maastricht University Medical Center+
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Kontakt:
- M. E. Bruins
- Telefonnummer: +3120 566 9111
- E-post: m.e.bruins@amsterdamumc.nl
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Nijmegen, Nederländerna
- Har inte rekryterat ännu
- Radboud University Medical Center
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Kontakt:
- M. E. Bruins
- Telefonnummer: +3120 566 9111
- E-post: m.e.bruins@amsterdamumc.nl
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Rotterdam, Nederländerna
- Har inte rekryterat ännu
- Erasmus MC University Medical Center
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Kontakt:
- M. E. Bruins
- Telefonnummer: +3120 566 9111
- E-post: m.e.bruins@amsterdamumc.nl
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Zwolle, Nederländerna
- Har inte rekryterat ännu
- Isala
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Kontakt:
- M. E. Bruins
- Telefonnummer: +3120 566 9111
- E-post: m.e.bruins@umcg.nl
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Provincie Groningen
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Groningen, Provincie Groningen, Nederländerna
- Rekrytering
- University Medical Center Groningen
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Kontakt:
- Mariëlle E. Bruins
- Telefonnummer: +31 50 361 6161
- E-post: m.e.bruins@umcg.nl
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-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
- Pregnant women with a singleton pregnancy between 24 weeks and 0 days and 31 weeks and 6 days with severe, early-onset fetal growth restriction, admitted in hospital or frequently evaluated ambulatory by CTG (according to local protocol) for fetal monitoring.
- Fetal growth restriction is defined in line with the international Delphi consensus as biometric ultrasound measurement of the abdominal circumference (AC) OR a combination of measurements resulting in an estimated fetal weight (EFW) below the 3rd percentile (<p3) OR a combination of EFW <p10 AND uterine artery pulsatility index (PI) >p95 OR umbilical artery Doppler PI >p95.
- Maternal age ≥ 18 years.
- Able to provide written informed consent for collection and use of data on informed consent form in available language.
Exclusion Criteria:
- Known congenital or chromosomal anomalies influencing perinatal outcome.
- Imminent labour or expected maternal indication for delivery < 48 hours.
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Ingen (Open Label)
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Aktiv komparator: Visual interpretation of cardiotocography
Monitoring by visual interpretation of cardiotocography |
Visual interpretation of cardiotocography |
|
Experimentell: Short term variation
Short term variation by computer software analysis |
Short term variation in computer software analysis |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Proportion of pregnancies resulting in perinatal death
Tidsram: Before discharge from neonatal intensive care unit (NICU), up to 1 year
|
Perinatal death is defined as antenatal death or neonatal/infant death before discharge from NICU |
Before discharge from neonatal intensive care unit (NICU), up to 1 year
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Proportion of children with major neonatal morbidity
Tidsram: Before discharge from NICU, up to 1 year
|
Major neonatal morbidity is a composite outcome defined as intraventricular hemorrhage grade 3 or more, periventricular leukomalacia grade 2 or more, moderate or severe bronchopulmonary dysplasia, necrotizing enterocolitis Bell stage 2 or more, or retinopathy of prematurity requiring therapy. |
Before discharge from NICU, up to 1 year
|
|
Proportion of children with neonatal morbidities
Tidsram: Before discharge from NICU, up to 1 year
|
Individual neonatal morbidities of the abovementioned composite outcome and additionally persisting ductus arteriosus, persistent pulmonary hypertension of the newborn (PPHN), respiratory distress syndrome (RDS), period of invasive mechanical ventilation in days, medication need, hypoglycaemia, neonatal jaundice, sepsis and cardiovascular function. |
Before discharge from NICU, up to 1 year
|
|
Proportion of children with neurodevelopmental impairment
Tidsram: At two years of corrected age
|
Neurodevelopmental impairment is defined as an abnormal test on Bayley III Dutch version (or version IV if available) (composite cognitive score < 85, composite motor score < 85), cerebral palsy, with a Gross Motor Function Classification System (GMFCS) grade > 1, hearing loss needing hearing aids, or severe visual loss (legally certifiable as blind or partially sighted) assessed at two years of corrected age |
At two years of corrected age
|
Samarbetspartners och utredare
Utredare
- Huvudutredare: Wessel Ganzevoort, MD PhD, Amsterdam UMC
Publikationer och användbara länkar
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Beräknad)
Avslutad studie (Beräknad)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Ytterligare relevanta MeSH-villkor
- Urogenitala sjukdomar
- Patologiska processer
- Kvinnliga urogenitala sjukdomar och graviditetskomplikationer
- Graviditetskomplikationer
- Död
- Fostersjukdomar
- Tillväxtstörningar
- Medfödda, ärftliga och neonatala sjukdomar och abnormiteter
- Patologiska tillstånd, tecken och symtom
- Fostrets tillväxthämning
- Perinatal död
Andra studie-ID-nummer
- 84591
Plan för individuella deltagardata (IPD)
Planerar du att dela individuella deltagardata (IPD)?
IPD-planbeskrivning
There is no current plan, but data will be available upon collaboration request
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