Serum Assessment of Preterm Birth Outcomes Compared to Historical Controls: AVERT PRETERM TRIAL

Preterm Birth Clinical Trial

Official title: Serum Assessment of Preterm Birth: Outcomes Compared to Historical Controls

Status Active, not recruiting

Clinical Trial Summary

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Recently treatments early in pregnancy such as progesterone, cervical support and maternal support have been demonstrated to delay delivery amongst at risk women. Nonetheless, the majority of women who are at risk are not identified using current screening modalities.

Hypothesis: A cohort of pregnancies who are screened using the PreTRM® test around 20 weeks gestation in which a bundle of interventions is given for elevated PreTRM® risk will show either decreased neonatal morbidity/and mortality (measured as a composite score, "NMI"), or decreased length of neonatal stay in the hospital (NNOLOS). Secondarily, they will show an increase in gestational age at birth (GAB) and a reduction in length of neonatal NICU stay (NICULOS), compared to an unscreened historical control group.

Study Design Type: Prospective cohort study of screened women compared to a historical control of 10000 women.

Clinical Trial Description

Population: Women who are 18 years or older, with a singleton pregnancy between 195/7 weeks and 206/7 weeks gestational age (GA) confirmed by ultrasound prior to enrollment, and no history of prior preterm birth (delivery between 160/7 weeks and 366/7 weeks) will be invited to participate. A comparable population will be identified using a historical control group in a contemporaneously maintained database.

Intervention: Qualifying women will be screened using the PreTRM® test (Sera Prognostics, Inc.) at a large tertiary care center. Predicated upon the degree of risk, women will be treated according to a prespecified algorithm. The outcomes of these women will be compared to a historical control group at the same tertiary care center.

Outcomes:

Primary outcome: Co-Primary outcomes: To determine whether a cohort of women who are screened with the PreTRM® test and then managed according to a prespecified protocol will have statistically significant reductions in either (a) composite neonatal morbidity and mortality (NMI score), or (b) length of neonatal hospital stay (NNOLOS), compared to a historical control group. The NMI is defined below

DEFINITIONS OF COMPOSITE PERINATAL MORTALITY/NEONATAL MORBIDITY OUTCOME SCORES:

1) 0 to 4 scale without NICU: This score was derived as an ordinal scale based upon severity. The score was defined by the following: 0 = no events;

1. = one event for (RDS, BPD, grade III or IV IVH, PVL, proven sepsis, or NEC) and no perinatal mortality,

2. = two events and no perinatal mortality;

3. = three or more events and no perinatal mortality; 4=perinatal mortality.

2) 0 to 4 scale with NICU: This score was defined as the following: 0 = no events,

1. = one event for (RDS, BPD, grade III or IV IVH, PVL, proven sepsis, or NEC) or <5 days in the NICU, and no perinatal mortality;

2. = two events or between 5 and 20 days in the NICU, and no perinatal mortality;

3. = three or more events or >20 days in the NICU, and no perinatal mortality;

4. = perinatal mortality.

3) 0 to 6 scale without NICU: This score was defined as the following: 0 = no events;

1. = one event for (RDS, BPD, grade III or IV IVH, proven sepsis, or NEC) and no perinatal mortality,

2. = two events and no perinatal mortality;

3. = three events and no perinatal mortality;

4. = four events and no perinatal mortality;

5. = five events and no perinatal mortality;

6. = perinatal mortality.

4) Any morbidity or mortality event: (yes/no)

• Adapted from Hassan SS, et al. Ultrasound Obstet Gynecol 2011; 38:18-31 Supplementary Information

Secondary outcomes: To determine whether women who are screened with the PreTRM® test and then managed according to a pre-specified treatment algorithm will have a statistically significant reduction in proportion of any type of preterm births (spontaneous and indicated), the total length of hospital stay for spontaneous preterm births, and total length of hospital stay for any preterm birth.

Observations:

• Neonatal death and stillbirth

• Birth weight and number of subjects with birth weight <1500g and <2500g

• Total number of days spent in the NICU and nursery

• Composite neonatal morbidity score and components

• Whether or not received surfactant

• Occurrence of pneumonia

• Number of days of mechanical ventilation

• Number of subjects with 5 minute Apgar < 7

• Occurrence of asphyxia

• Number of preterm deliveries at <37, <35 and <32 weeks

• Occurrence of preeclampsia

• Proportion of primiparous women experiencing preterm birth and spontaneous preterm birth

• NICU days for spontaneous preterm birth in primiparous women in prospective treatment arm are significantly less than NICU days in primiparous women in the control group of sPTB

• Correlation of blood levels of 17-OHPC and other progestin levels to outcomes and observations

General Outcomes:

Total cost of hospital care for both the mother and fetus beginning at initiation of care through primary delivery and 28 days of life. ;

Related Conditions & MeSH terms

• Premature Birth
• Preterm Birth

• NCT number: NCT03151330
• Study type: Interventional
• Source: Christiana Care Health Services
• Status: Active, not recruiting
• Phase: N/A
• Start date: June 15, 2018
• Completion date: November 1, 2023