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DISPATCH: Decreasing Intervention Using sFlt-1/PlGF Applied to Chronic Hypertension (DISPATCH)

9 november 2026 uppdaterad av: University of California, San Francisco

Decreasing Intervention Using sFlt-1/PlGF Applied to Chronic Hypertension (DISPATCH Trial): A Pilot, Open-label, Randomized Controlled Trial

This pilot study tests the feasibility of conducting an interventional study in pregnant people with chronic hypertension with interventional clinical management based on sFlt-1/PlGF. It will also collect data on time to delivery, the incidence of preterm delivery, and other maternal or neonatal complications, for a pivotal trial.

Studieöversikt

Status

Har inte rekryterat ännu

Betingelser

Intervention / Behandling

Detaljerad beskrivning

Participants with chronic hypertension between 23+0 and 34+6 weeks presenting to triage for rule out superimposed preeclampsia. They will be randomly assigned to two groups at a 1:1 ratio, conceal or reveal, and will be tested with the sFlt-1/PlGF assay. In the conceal group, participants will have their blood tested but the results will not be returned to the participants or their clinical providers, and thus the participants will continue to receive routine clinical care in pregnancy. In the reveal group, the clinical team will be notified of the assay results (PlGF and sFlt-1 concentrations and ratio) and result status (normal <40 or abnormal using the cut-off ≥40) and will be encouraged to discharge patients with a normal result. The ultimate decision to admit or discharge will still be based on the decision making of the clinical team; if a patient with a normal result is admitted and/or delivered, the clinical team will be asked to record the reason(s) behind the decision(s). Repeat PlGF and sFlt-1 concentration and ratio testing will occur for participants who re-present to triage ≥7 days from the prior test, and on a weekly basis for participants who are admitted. For participants in the reveal group who have had an abnormal result, additional concentration and ratio testing will be performed but results will not be reported to the clinical team.

Studietyp

Interventionell

Inskrivning (Beräknad)

74

Fas

  • Inte tillämpbar

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studiekontakt

Studera Kontakt Backup

Studieorter

  • Förenta staterna
    • California
      • San Francisco, California, Förenta staterna, 94158
        • University of California, San Francisco

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år och äldre (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Kvinna

Beskrivning

Inclusion Criteria:

  • Age 18 and older

  • Singleton living pregnancy

  • Gestational age between 23+0 and 34+6 weeks gestation, confirmed by a fetal crown-rump length measurement in a first trimester ultrasound or by in vitro fertilization dates

  • Chronic hypertension, defined as:

    • At least 2 blood pressure measurements 140 systolic or 90 diastolic 4 hours apart diagnosed at less than 20 weeks 0 days of gestation and within 12 months of conception.
    • History or current use of anti-hypertensive medications for the indication of lowering blood pressure within 12 months prior to conception or prior to 20 weeks 0 days in the current pregnancy. Use during a prior pregnancy and through 12 weeks postpartum, or use for stage 1 chronic hypertension are not exclusions.

  • Evaluated in triage for worsening chronic hypertension, rule out preeclampsia due to:

    • Worsening blood pressures from baseline and/or development of severe range blood pressures
    • Preeclampsia associated symptoms: headache, vision changes, abdominal pain
    • New onset proteinuria or worsening proteinuria
    • Lab abnormalities suspicious for preeclampsia including anemia, signs of hemolysis, thrombocytopenia, increasing serum creatinine, elevated liver function tests
    • Any other concerning features of preeclampsia according to the evaluating clinician

Exclusion Criteria:

  • Hemolysis, elevated liver enzymes, low platelet syndrome (HELLP syndrome), pulmonary edema, eclamptic seizure, stroke, myocardial infarction, placental abruption, or heart failure.
  • Absent or reversed end-diastolic flow in the umbilical artery Doppler
  • Unable to consent
  • Major birth defect or chromosomal abnormality that may necessitate preterm birth for other reasons
  • Other pregnancy complication that may necessitate preterm birth (e.g., PPROM)
  • IV Heparin use within 24 hours of the lab draw
  • Exogenous PlGF-2 or PlGF-3 given for therapeutic use at a concentration higher than 100 pg/mL

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Diagnostisk
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Placebo-jämförare: Conceal arm

The clinical team will be blinded to assay results and will manage as per their usual clinical protocol.
Diagnostiskt test: sFlt/PlGF without change in clinical care

Diagnostic testing with sFlt/PlGF assay at each obstetric emergency room or admission in which the participant is being evaluated for preeclampsia. Testing will occur at each evaluation or if the participant is admitted to the hospital, weekly.

Conceal arm: The clinical team will be blinded to assay results and will manage chronic hypertension as per their usual clinical protocol.
Experimentell: Reveal arm

The clinical team will receive qualitative assay results normal (sFlt-1/PlGF <40) or abnormal (sFlt-1/PlGF ³40)) and the ratio value and concentrations of PlGF and sFlt-1.
Diagnostiskt test: sFlt/PlGF lab assay with change in clinical care

Diagnostic testing with sFlt/PlGF assay at each obstetric emergency room or admission in which the participant is being evaluated for preeclampsia. Testing will occur at each evaluation or if the participant is admitted to the hospital, weekly.

Reveal arm: the clinical team will receive qualitative assay results normal (sFlt-1/PlGF <40) or abnormal (sFlt-1/PlGF >=40).

  • If normal, the clinical team will be encouraged to manage the patient expectantly, with discharge home and routine outpatient surveillance or if the patient is admitted, to continue expectant management without delivery. If a patient with a normal result is admitted and/or delivered, the clinical team will be asked to record the reason(s) behind the decision(s).
  • If abnormal, the clinical team should consider superimposed preeclampsia and will manage per their usual clinical protocol. If a patient with an abnormal result is discharged, the clinical team will be asked to record the reason(s) behind the decision(s).

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Recruitment rate
Tidsram: At month 6

Number of participants enrolled per week
At month 6
Protocol adherence in the reveal arm
Tidsram: At month 6

What proportion of participants in the reveal arm adhered to the clinical algorithm of management based on the assay result.
At month 6

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Time until delivery using a time-to-event analysis
Tidsram: From date of randomization until the date of delivery

Assessing weeks from the initial enrollment in the trial to delivery
From date of randomization until the date of delivery
Delivery with superimposed preeclampsia with severe features.
Tidsram: At the date of delivery

The endpoint will be analyzed for different follow-up times including <35 weeks of gestation. Analysis will take into account the potentially diverging directions of the effect in the patient strata of ratio results (levels: "abnormal", "normal"; cut-off 40; assuming reduction of deliveries in the "normal" stratum and increase in the "abnormal" stratum due to improved risk stratification by the ratio), e.g. by using (a) regression modelling with interaction term study arm x ratio result, or (b) stratification of the analysis by ratio result.
At the date of delivery
Rate of preterm birth at <35 weeks
Tidsram: At month 6
At month 6
Rate of preterm birth at <37 weeks
Tidsram: At month 6
At month 6
Maternal admission rate
Tidsram: At month 6

1) defined as the number of participants admitted at least once in the antepartum period divided by the total number of participants in that arm of the trial and 2) defined as the number of participants admitted at least once in the postpartum period divided by the total number of participants in that arm of the trial
At month 6
Maternal admission days
Tidsram: Date of randomization to 6 weeks postpartum

Defined 1) randomization to delivery and 2) in the postpartum period up to 6 weeks
Date of randomization to 6 weeks postpartum
Maternal admission to the ICU
Tidsram: Date of randomization to 6 weeks postpartum

1) in pregnancy or 2) within 6 weeks postpartum
Date of randomization to 6 weeks postpartum
Severe maternal morbidity (with and without transfusion)
Tidsram: Date of randomization to 6 weeks postpartum

Severe maternal morbidity (without transfusion) is defined as the occurrence of at least one of the following during pregnancy, delivery, or in the first 6 weeks postpartum: acute myocardial infarction, aneurysm, acute renal failure, adult respiratory distress syndrome, amniotic fluid embolism, cardiac arrest or conversion of cardiac rhythm, disseminated intravascular coagulation, eclampsia, hemorrhagic or embolic stroke, pulmonary edema, severe anesthesia complication, sepsis, shock, sickle cell disease with crisis, air and thrombotic embolism, hysterectomy, temporary tracheostomy, mechanical ventilation
Date of randomization to 6 weeks postpartum
Gestational age at delivery
Tidsram: Date of delivery
Date of delivery
Birthweight
Tidsram: Date of delivery
Date of delivery
Birthweight percentile
Tidsram: Date of delivery
Date of delivery
Mode of delivery
Tidsram: Date of delivery
Date of delivery
Neonatal admission to the NICU
Tidsram: Date of delivery
Date of delivery
Days of neonatal admission to the NICU
Tidsram: Date of delivery to 6 weeks postpartum
Date of delivery to 6 weeks postpartum
Neonatal composite morbidity
Tidsram: Date of delivery to 6 weeks postpartum
  • Neonatal major morbidity as measured in pregnancy and up to 6 weeks postpartum is defined as the occurrence of at least one of the following: death (fetal or neonatal death through 28 days postpartum), hypoxic ischemic encephalopathy, intraventricular hemorrhage, cardiopulmonary resuscitation, necrotizing enterocolitis, persistent pulmonary hypertension, bronchopulmonary dysplasia, mechanical ventilation, seizure, sepsis, birth trauma (fracture, brachial plexus injury, facial palsy)
  • Neonatal minor morbidity as measured in pregnancy and up to 6 weeks postpartum is defined as the occurrence of at least one of the following: respiratory distress syndrome, hypoglycemia, meconium aspiration syndrome, and neonatal jaundice requiring phototherapy
Date of delivery to 6 weeks postpartum

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of California, San Francisco

Utredare

  • Huvudutredare: Juan M Gonzalez Velez, MD PhD, University of California, San Francisco

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart (Beräknad)

1 januari 2027

Primärt slutförande (Beräknad)

1 juli 2027

Avslutad studie (Beräknad)

1 juli 2027

Studieregistreringsdatum

Först inskickad

4 november 2026

Först inskickad som uppfyllde QC-kriterierna

9 november 2026

Första postat (Faktisk)

13 november 2026

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

13 november 2026

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

9 november 2026

Senast verifierad

1 november 2026

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • STUDY00000922

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NEJ

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