Clinical Trials Logo

Clinical Trial Details — Status: Terminated

Administrative data

NCT number NCT01279369
Other study ID # 117104-4
Secondary ID
Status Terminated
Phase
First received
Last updated
Start date October 2009
Est. completion date October 2012

Study information

Verified date May 2018
Source Winthrop University Hospital
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

The purpose of this study is to determine if the presence of fetal fibronectin in the cervicovaginal secretions of pregnant patients with minor maternal trauma predicts impending preterm delivery due to abruptio placenta.


Description:

Optimal care of the pregnant trauma patient requires prompt and efficient care by a multidisciplinary team to evaluate both maternal and fetal status. Approximately 7% of pregnancies are complicated by trauma and traumatic injury remains the leading cause of non-obstetric maternal death.1-3 In the case of major or life-threatening trauma in pregnancy, assessment and stabilization of maternal cardiovascular and respiratory status is paramount and management is generally dictated by standard adult advanced cardiovascular support algorithms. In contrast, the evaluation and management of minor trauma in pregnancy is variable and often provider dependent.4-7 Regardless of the clinical and laboratory evaluation performed, the universal goal is to prevent maternal injury or death and optimize pregnancy outcomes.

Maternal trauma has been associated with adverse pregnancy outcome, including preterm labor, abruptio placenta, uterine rupture and fetal death.8, 9 Traditional trauma scoring systems correlate well with the severity of maternal injury and are useful in triaging the mother; however, these scoring systems have not been predictive of adverse pregnancy outcome.10,11 Major or life-threatening maternal trauma, which includes maternal shock, head injury resulting in coma, and emergency laparotomy for maternal indications is associated with a 40-50% fetal loss rate as compared to 1-5% in pregnant women after minor trauma. The risk of preterm labor after maternal trauma is increased 2-fold and the prevalence of abruptio placenta after minor blunt abdominal trauma is reported at 8%. 3,6-9,12

Upon initial evaluation in the obstetrical triage setting, the examination of maternal trauma patients is focused on detection of impending labor or abruptio placenta. This evaluation includes detailed history of the accident, physical examination, abdominal and transvaginal ultrasound to evaluate placental location and/or evidence of placental abruption and cervical length, external uterine contraction monitoring, continuous fetal heart rate monitoring and blood tests such as CBC, blood type, coagulation profile and Kleihauer-Betke staining. Although much has been written on the subject of trauma during pregnancy, there is little concrete data on objective measures which can be used to dictate triage and management decisions. A recent study by Cahill et al.13 has advocated for review of the extensive evaluations often performed after maternal trauma, specifically minor trauma, because they determined that none of the commonly used clinical and laboratory measures are predictive of adverse outcomes. Identification of laboratory measures predictive of impending delivery due to placental abruption will potentially enable physicians to individualize triage and evaluation of the maternal trauma patient, as well as direct treatment and management.

Fetal fibronectin is an extracellular matrix protein that is normally found in the fetal membranes and decidua.14 It is essentially an adhesive glycoprotein or "glue" at the maternal-fetal interface. In a normal pregnancy, fFN is undetectable in vaginal secretions from weeks 22 to 35. Disruption of the maternal-fetal interface causes the release of fFN into cervical and vaginal secretions. Detection of fFN before the normal onset of labor is an indicator of preterm birth risk, allowing opportunity to provide appropriate intervention. According to previous studies, the clinical utility of fFN lies in its negative predictive value. In non-trauma patients, the sensitivity of fFN in predicting impending delivery (within 7 days) is greater than 90%. A negative fFN result can be used to rule out impending deliver with greater than 99% certainty.15

Because abruptio placenta secondary to maternal trauma is the result of shearing forces separating the placenta from the uterine decidua, this outcome could potentially be predicted by a positive fFN result. This study is therefore undertaken to determine if the presence of fFN in cervicovaginal secretions is predictive of impending delivery or placental abruption in patients with maternal trauma. With better knowledge of the probable outcomes following maternal trauma and using the appropriate diagnostic and therapeutic modalities, optimal care following minor maternal trauma for the pregnant patient and fetus can be provided.


Recruitment information / eligibility

Status Terminated
Enrollment 3
Est. completion date October 2012
Est. primary completion date October 2012
Accepts healthy volunteers No
Gender Female
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Singleton intrauterine pregnancy =20 weeks and =35 weeks gestational age

- Chief complaint of minor maternal trauma including motor vehicle accident, patient fall or assault with absence of maternal conditions outlined in exclusion criteria

Exclusion Criteria:

- Maternal shock

- Unstable vital signs

- Altered sensorium

- Head injury resulting in coma

- signs or symptoms of intraperitoneal bleeding

- Emergency laparotomy for fetal or maternal indications

- Bone fractures

- History of previous abruptio placenta

- Known or suspected placenta previa

- Rupture of membranes

- Multiple gestation

- Advanced cervical dilatation =3cm

- Non-reassuring fetal status requiring intervention

- Vaginal bleeding on presentation

- History of intercourse and/or digital vaginal exam and/or vaginal ultrasound =24 hours prior to presentation

- Illicit drug use

Study Design


Locations

Country Name City State
United States Winthrop University Hospital Mineola New York

Sponsors (1)

Lead Sponsor Collaborator
Winthrop University Hospital

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Delivery within 2 weeks of the trauma event 2 weeks
See also
  Status Clinical Trial Phase
Completed NCT05017974 - Research on Improving Sleep During Pregnancy N/A
Completed NCT03284515 - Vaccination In Pregnancy Gene Signature: VIP Signature Study
Recruiting NCT05969795 - Comparison of Live Birth Rate in Natural Cycle Single Euploid FET Versus Without Luteal Phase Support Phase 1
Recruiting NCT06051201 - Innovation for Small-scale Experiments: ReceptIVFity Test N/A
Recruiting NCT04828382 - Prospective Study of Pregnancy in Women With Cystic Fibrosis
Enrolling by invitation NCT04527926 - STEPuP: Prenatal Provider Education and Training to Improve Medication-assisted Treatment Use During Pregnancy N/A
Recruiting NCT04278651 - Early Antenatal Support for Iron Deficiency Anemia Phase 4
Recruiting NCT04405700 - Measuring Adverse Pregnancy and Newborn Congenital Outcomes
Recruiting NCT06258902 - Odevixibat Pregnancy and Lactation Surveillance Program: A Study to Evaluate the Safety of Odevixibat During Pregnancy and/or Lactation
Completed NCT05487196 - Effectiveness of Clonidine, Dexmedetomidine, and Fentanyl Adjuncts for Labor Epidural Analgesia Phase 2
Completed NCT03750968 - Lutein & Zeaxanthin in Pregnancy - Carotenoid Supplementation During Pregnancy: Ocular and Systemic Effects Phase 2
Enrolling by invitation NCT06127277 - Next4You: A Fully Mobile Relationships Based Program for Youth in Foster Care N/A
Completed NCT05897697 - Assessing Women's Preferences for Postpartum Thromboprophylaxis: the Prefer-Postpartum Study
Recruiting NCT05899101 - The Impact of Opioid and Cannabis Exposure on Fetal Growth
Completed NCT05502510 - Assessing the Effectiveness and Efficacy of the MyHealthyPregnancy Application
Completed NCT04296396 - Opioid Prescription After Cesarean Trial Phase 3
Not yet recruiting NCT06069856 - Multiple Micronutrient Supplementation (MMS) IFA- Iron Dose Acceptability Crossover Trial Phase 3
Not yet recruiting NCT06069869 - Multiple Micronutrient Supplementation (MMS) Iron Dose Acceptability Crossover Trial Phase 3
Not yet recruiting NCT06163651 - Evaluating a One-Year Version of the Parent-Child Assistance Program N/A
Not yet recruiting NCT06079918 - Multiple Micronutrient Supplementation for Maternal Anemia Prevention in Tanzania Phase 3