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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT04075630
Other study ID # NIMAO/2018-03/BC-01
Secondary ID
Status Recruiting
Phase
First received
Last updated
Start date October 2, 2019
Est. completion date April 2024

Study information

Verified date January 2024
Source Centre Hospitalier Universitaire de Nimes
Contact vincent letouzey, M.
Phone 0466686868
Email vincent.letouzey@chu-nimes.fr
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Our hypothesis is that there is one sequence of labour-induction that leads to a better experience of childbirth than others. This is based on the following underlying theories : - Maternal satisfaction depends on the number of labour-inducing sequences - A longer labour-induction would be experienced less positively than a shorter one - The experience is correlated with maternal outcomes ( vaginal / Caesarian delivery, spontaneous birth or instrument-assisted birth, maternal complications ) and neonatal outcomes (neonatal complications, secondary hospitalization).


Description:

Artificial labour induction is a medical intervention used in the interest of the mother or unborn child, aimed at provoking birth by inducing uterine contractions artificially, leading to cervical effacement and dilation. The purpose is to end the pregnancy in the interest of the mother and/or foetus. According to the latest results of the Perinatal Enquiry (2016), induced labour rates total around 22% of pregnancies (767.000 births in 2017) in all maternity clinics. For the university hospitals of Nimes and Montpellier, with Level 3 maternity units (thus requiring a higher rate of inductions), this represents 515 and 550 pregnancies respectively (2017 figures). There are several methods of inducing labour: use of a cervical ripening balloon (a medical device with which the onset of labour is provoked mechanically), vaginal inserts containing prostaglandins or intravenous perfusion with oxytocin combined with water-breakage. These labour-induction methods may be used alone or in succession depending on the evaluation of the cervix using the Bishop score as a reference. Each method has its own benefits and risks. There is variability between establishments in the protocols used for cervical ripening. The Nimes and Montpellier centres both use the same methods, but with different sequences. Studies are mainly devoted to evaluating each method individually in terms childbirth by vaginal delivery and duration of labour. Maternal satisfaction, which is a rarely studied multifactorial evaluation, is correlated with women's psychological outcome. A bad experience during childbirth appears to increase the risk of post-partum (PP) psychological disorders. Considering the current literature available, although there have been trials comparing two isolated labour-induction methods, like the study by Probaat (Jozwiak et al., 2013), which compared obstetrical and neonatal outcomes with the cervical ripening balloon and the prostaglandin insert, none of these studies investigated their impact on maternal satisfaction. Although there have been a few studies evaluating maternal satisfaction at childbirth, there have not been any evaluating satisfaction during artificial labour-induction in a pragmatic situation. The aim of our study was therefore to evaluate the impact on semi-immediate maternal satisfaction under pragmatic, real-life conditions depending on the various possible induction scenarios (both in terms of the number of methods used, from 1 to 3, and the possible combinations when at least 2 or more methods were used ).


Recruitment information / eligibility

Status Recruiting
Enrollment 900
Est. completion date April 2024
Est. primary completion date January 9, 2024
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria: The patient has made no formal opposition to taking part in the study. - The patient must be affiliated to/have the benefit of a health insurance scheme. - The patient is at least 18 years old. - The patient is capable of understanding the instructions required for answering questionnaires in French. Concerning the targeted population: - The patient has a medical indication for labour-induction. - Term = 37 weeks. - The foetus is alive and viable, without any known lethal pathology Exclusion Criteria: The person is in a period of exclusion determined by a previous study. - The person has been placed under judicial protection and is under guardianship or curatorship. - It is impossible to give the person accurate information. Non-inclusion criteria concern associated illnesses or interfering conditions: - The patient does not have the possibility to answer the questionnaire at 1 month - Contra-indication for labour-induction or vaginal delivery - Foetal presentation other than cephalic.

Study Design


Related Conditions & MeSH terms


Locations

Country Name City State
France CHU Arnaud de Villeneuve Service de Gynécologie Obstétrique Montpellier Hérault
France Centre Hospitalier Universitaire Nîmes Gard

Sponsors (1)

Lead Sponsor Collaborator
Centre Hospitalier Universitaire de Nimes

Country where clinical trial is conducted

France, 

Outcome

Type Measure Description Time frame Safety issue
Primary Overall patient satisfaction Overall patient satisfaction evaluated via a 4-point Likert scale (1= not satisfied, 2 = moderately satisfied, 3 = satisfied, 4 = very satisfied) on a touchscreen. 2 hours after giving birth
Secondary Patient satisfaction evaluated via the W-DEQ questionnaire The Wijma Delivery Experience Questionnaire (W-DEQ) is a Scandinavian questionnaire (designed by Wijma et al. in 1998) translated into French. It evaluates the patient's true experience of childbirth compared with her expectations. It has 33 items based on recurring fears of pregnant women, divided into several catégories (fear, negative feelings, lack of confidence, behaviour etc…). 2 hours after giving birth
Secondary Post-partum QEVA satisfaction questionnaire The pluridimensional Questionnaire d'Evaluation du Vécu de l'Accouchement (QEVA) known in English as the QACE (Questionnaire for Assessing the Childbirth Experience is used to evaluate the patient's experience of childbirth. It contains 25 items, each with a 4-point Likert scale, divided into the following categories: relationship with healthcare teams, emotions (positive and negative), first moments with the newborn baby, situation one month after childbirth. An e-mail is sent to the patient 1 month after giving birth, asking her to complete the QEVA by logging onto a dedicated platform. 1-2 months after giving birth
Secondary Different methods of labour-induction used Data collection from medical files on the methods of labour-induction used (alone or successively), duration of use and intermediate Bishop scores. This a pre-labor scoring system reflecting cervical modification ranges from 0 to 3 (0= cervix closed and 3 = dilated to more than 5 cm) assists in predicting whether labour-induction will be required and the likelihood of spontaneous preterm delivery. 6 months after giving birth
Secondary Spontaneous vaginal deliveries Rate of spontaneous vaginal deliveries, 48 hours maximum
Secondary Rate of instrument-assisted vaginal deliveries Rate of instrument-assisted vaginal deliveries. 48 hours maximum
Secondary Reason for instrument-assisted vaginal deliveries Reason for instrument-assisted vaginal deliveries (non progression of fœtal presentation, fœtal distress, maternal complications). 48 hours maximum
Secondary Type of instrument-assisted vaginal deliveries Type of instrumental extraction used for the delivery
.
48 hours maximum
Secondary Rate of Caesarian births Rate of Caesarian births and reason (no cervical dilatation at the first stage of labour : dilatation 0 to 10cm, absence of fœtal descent at stage 2 of labour, fœtal cause, maternal cause). 48 hours maximum
Secondary Reason for Caesarian births Reason for Caesarian birth (no cervical dilatation at the first stage of labour : dilatation 0 to 10cm, absence of fœtal descent at stage 2 of labour, fœtal cause, maternal cause). 48 hours maximum
Secondary Time from start of labour-induction to start of labour Time between the start of labour-induction and the onset of labour will be measured 48 hours maximum
Secondary Time from labour-induction to birth (Caesarian births excluded), Time from labour-induction to vaginal delivery 48 hours maximum
Secondary Vaginal deliveries at H12 Rate of vaginal deliveries at 12 hours from start of labour-induction 12 hours from start of induction
Secondary Vaginal deliveries at H24 Rate of vaginal deliveries at 24 hours from start of labour-induction 24 hours from start of induction
Secondary Vaginal deliveries at H48 Rate of vaginal deliveries at 48 hours from start of labour-induction 48 hours from start of induction
Secondary Labour-induction failures Rate of labour-induction failures giving rise to a Caesarian due to the duration of the latency phase (0-6cm) =24h with oxytocine administered for at least 12-18h after artificial water-breakage. 12 - 18 hours
Secondary Propess Rate of secondary or tertiary use of Propess (vaginal prostaglandine inserts) up to 48 hours before birth
Secondary Balloon/Foley bulb Rate of secondary or tertiary use of the cervical ripening balloon (Foley bulb) 48 hours maximum
Secondary Oxytocine Rate of secondary or tertiary use of intravenous Oxytocine 48 hours maximum
Secondary Epidurals Rate of epidural anesthaesia during labour 48 hours maximum
Secondary Bishop score evolution: Propess The Bishop score,developed by Professor Emeritus of Obstetrics and Gynecology Dr. Edward Bishop, is also known as cervix score. It is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It is based on 5 points : Cervical dilation in centimeters, cervical effacement as a percentage,cervical consistency by provider assessment/judgement, cervical position, fetal station (the position of the fetal head in relation to the pelvic bones).The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require a cervical ripening method (pharmacologic or physical, such as a Foley bulb). Until birth (48 hours maximum)
Secondary Bishop score evolution: Balloon/Foley bulb The Bishop score,developed by Professor Emeritus of Obstetrics and Gynecology Dr. Edward Bishop, is also known as cervix score. It is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It is based on 5 points : Cervical dilation in centimeters, cervical effacement as a percentage,cervical consistency by provider assessment/judgement, cervical position, fetal station (the position of the fetal head in relation to the pelvic bones).The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require a cervical ripening method (pharmacologic or physical, such as a Foley bulb). Until birth (48 hours maximum)
Secondary Bishop score evolution: Ocytocine The Bishop score,developed by Professor Emeritus of Obstetrics and Gynecology Dr. Edward Bishop, is also known as cervix score. It is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It is based on 5 points : Cervical dilation in centimeters, cervical effacement as a percentage,cervical consistency by provider assessment/judgement, cervical position, fetal station (the position of the fetal head in relation to the pelvic bones).The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require a cervical ripening method (pharmacologic or physical, such as a Foley bulb). Until birth (48 hours maximum)
Secondary Maternal morbidity Rate of uterine hyperstimulation(> 6 contractions in 10 minutes on 2 occasions) with or without an effect on the foetus 6 months after giving birth
Secondary Maternal morbidity Rate of uterine hypertonia (contraction > 2 minutes with slowing down of fœtal heartbeat) 48 hours maximum
Secondary Maternal morbidity: moderate haemorrhage Rate of post partum haemorrage = 500ml, rate of severe post-partum haemorrhage =1000ml, rate of transfusion, number of packs of red blood cells transfused 48 hours maximum
Secondary Maternal morbidity: severe haemorrage rate of severe post-partum haemorrage =1000ml rate of transfusion, number of packs of red blood cells transfused 48 hours maximum
Secondary Maternal morbidity: transfusion rate Rate of transfusions 48 hours maximum
Secondary Maternal morbidity: amount of blood transfused This is measured in terms of the number of packs of red blood cells transfused 48 hours maximum
Secondary Maternal morbidity: rupture Rate of uterine rupture 48 hours maximum
Secondary Maternal morbidity: Chorioamniotitis Chorioamniotitis (temperature > 38°C with fœtal tachycardia > 160 beats / minute) 48 hours maximum
Secondary Maternal morbidity: infection Rate of post-partum infection (temperature > 38°C with antibiotherapy, urinary infection, bacteriologically-proven endometritis at 1 week post-partum) 1 week after giving birth
Secondary Neonatal morbidity:asphyxia Rate of neonatal asphyxia (umbilical cord arterial pH = 7.05, and/or APGAR at 5 minutes < 7). The Apgar score is a means of evaluating the vitality of a newborn based on the simple observation at the time of birth. The value is a prognostic for neonatal mortality. It was developed in 1952 by the American doctor, Virginia Apgar. 5 minutes after giving birth
Secondary Neonatal morbidity: neonatal hospitalisation Rate of neonatal pediatric hospitalisations up to 48 hours after giving birth
Secondary Neonatal morbidity: infection Bacteriologically-proven infection rate up to 48 hours after giving birth
Secondary Maternal tolerance: bleeding Metrorrhagia due to vaginal insert (dinoprostone) or cervical ripening balloon placement up to 48 hours after giving birth
Secondary Maternal tolerance: pain due to overinflation of the balloon (Foley bulb) Pain related to balloon inflation requiring secondary partial deflation, reorded with a VAS. The visual analog scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.The pain VAS is self-completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity up to 48 hours after giving birth
Secondary Maternal tolerance: pain on 1st induction sequence Pain level recorded with a VAS before the 1st induction sequence. The visual analog scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.The pain VAS is self-completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity up to 48 hours before birth
Secondary Maternal tolerance: pain after childbirth Pain level recorded with a VAS at H2 of childbirth. 2 hours after giving birth
Secondary Maternal tolerance: pain during childbirth Pain level at various times of labour-induction recorded with a VASThe visual analog scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.The pain VAS is self-completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity labour time
Secondary Maternal tolerance: pain due to insert or balloon (Foley bulb) Pain level recorded with a VAS before vaginal insert or balloon placement. The visual analog scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.The pain VAS is self-completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity up to 48 hours before birth
Secondary Maternal tolerance: pain due to insert or balloon (Foley bulb) at H2 Pain level recorded with a VAS 2 hours after vaginal insert or balloon placement. The visual analog scale is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.The pain VAS is self-completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at the point that represents their pain intensity 2 hours after device placement
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