High Risk Pregnancy Clinical Trial
— PIPOfficial title:
Functional Imaging of Human Placenta by MRI
Verified date | October 2020 |
Source | Oregon Health and Science University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Observational |
The purpose of this study is to test the application of newly generated magnetic resonance imaging (MRI) protocols for the assessment of placental perfusion in human subjects. The primary objective is to validate and establish the utility of placental MRI in pregnant women. The study will be entirely MRI-technology based with collection of placental tissue at the time of infant delivery for later correlative studies.
Status | Completed |
Enrollment | 379 |
Est. completion date | June 30, 2020 |
Est. primary completion date | June 30, 2020 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | Female |
Age group | 18 Years to 52 Years |
Eligibility |
Pregnant women will be recruited based on inclusion criteria for 3 subject groups: 1. Non-smokers with low risk for placental insufficiency 2. Smokers 3. Non-smokers who are at a high risk for adverse outcomes based on prior clinical history. Inclusion criteria: Pregnant women fulfilling inclusion criteria, and not meeting exclusion criteria, will be invited to participate in this study. Inclusion criteria for all groups: 1. Maternal age over 18 years and able to give informed consent 2. Pregnant patient, as defined by positive pregnancy test for elevated ß-human chorionic gonadotropin (HCG) and certain menstrual history, or early ultrasound, identified prior to 14 weeks of gestation Inclusion criteria for low risk group: 1. No history of a second or third trimester loss 2. No history of fetal growth restriction Inclusion criteria for high risk group: 1. History of pregnancy complicated by placental insufficiency in a previous singleton pregnancy (i.e. severe preeclampsia requiring preterm delivery, preterm delivery due to placenta insufficiency (eg. fetal growth restriction (FGR), oligohydramnios, abnormal umbilical artery Doppler's, abnormal antenatal testing), FGR <10% delivered at term; stillbirth attributed to placental cause, regardless of gestational age 2. Not currently a smoker 3. Pregnancy at risk for placental insufficiency due to clinical concerns (eg. chronic hypertension) 4. Spontaneous preterm birth <34 weeks Exclusion criteria: These criteria will exclude women whose medications, personality traits or obstetric conditions could confound their ability to complete a 1 hour MRI scan. 1. Individuals with intellectual disability or who are incarcerated 2. Multiple gestation 3. Major fetal anomalies known to be associated with abnormal growth (i.e. major congenital heart defect, gastroschisis) 4. Current maternal history of alcohol or illicit drug use 5. Current medical problems requiring chronic treatment: - Cancer - Active liver disease (acute hepatitis, chronic active hepatitis, persistently abnormal liver enzymes) - Chronic pulmonary disease including asthma requiring regular use of medication 6. Prior history of claustrophobia 7. Metal implants 8. Increased aneuploidy risk based on ultrasound findings or genetic testing |
Country | Name | City | State |
---|---|---|---|
United States | Oregon Health and Science University | Portland | Oregon |
United States | University of Utah | Salt Lake City | Utah |
Lead Sponsor | Collaborator |
---|---|
Oregon Health and Science University | Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Placental perfusion (Units of measure: ml/min) measured at 3 time points across gestation. | This will allow perfusion changes across pregnancy to be quantified in women from the three study groups. | Change from 16, 24, and 32 weeks gestation | |
Primary | Optimal cutoff values of placental MRI for placenta mediated adverse outcomes using receiver operating characteristics (ROC) | Determine the sensitivity and specificity of placental MRI at 16, 24, and 32 weeks gestation for identifying risk of adverse clinical outcome identified later in pregnancy. Optimal cutoff values of placental MRI for placenta mediated adverse outcomes using receiver operating characteristics (ROC). | Change from 16, 24, and 32 weeks gestation | |
Primary | Composite of placenta-mediated adverse pregnancy outcomes | A binary variable indication whether the placenta-mediated adverse pregnancy has observed within 39 weeks gestation Composite of placenta-mediated adverse pregnancy outcomes defined as the presence of at least one of the following: Fetal death (not due to genetic or infectious etiology), Preeclampsia or gestational hypertension, Small for gestational age fetus < 5%, Oligohydramnios (defined as amniotic fluid index (AFI) < 5 cm) prompting delivery prior to 39 weeks gestation, Abnormal fetal heart rate tracing prompting delivery prior to 39 weeks gestation, Abnormal umbilical artery Doppler velocimetry prompting delivery prior to 39 weeks gestation. |
39 weeks gestation | |
Secondary | Composite of Placenta histologic outcomes | Composite of placental histologic outcomes defined as the presence of one of the following: accelerated villous maturation abnormal villous cytotrophoblast proliferation microscopic infarctions decidual vasculopathy |
39 weeks gestation | |
Secondary | Diagnosis of preeclampsia using standard clinical criteria | 39 weeks gestation | ||
Secondary | Small for gestational age fetus at 3% and 5% | 39 weeks gestation | ||
Secondary | Gestational age at delivery prior to 37 weeks gestation. | 37 weeks gestation |
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