Vaginal Progesterone in Twins With Short Cervix

Premature Birth Clinical Trial

Official title:

Vaginal Progesterone to Prevent Early Preterm Birth In Twin Pregnancy With Short Cervix. Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT01812239
• Other study ID #: OBX0019
• Status: Withdrawn
• Phase: Phase 2/Phase 3
• First received: March 12, 2013
• Last updated: December 17, 2014
• Start date: March 2014
• Est. completion date: August 2018

Study information

• Verified date: December 2014
• Source: Mednax Center for Research, Education and Quality
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

A Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial of Vaginal Progesterone to Prevent Early Preterm Birth In Twin Pregnancy with Short Cervix.

Description:

This is a placebo-controlled, double-blind, randomized clinical trial of asymptomatic women with twin pregnancy and a cervix length 10 mm to 25 mm discovered on a routine screening transvaginal sonogram between 20w0d to 24w0d gestational age. Women will be randomized in either the in-patient or out-patient setting (1:1) to a daily vaginal application of micronized progesterone cream(200 mg)vs. placebo to determine if daily vaginal progesterone administration reduces the risk of preterm birth prior to 34w0d of gestation.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: August 2018
• Est. primary completion date: August 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 60 Years

Eligibility

Inclusion Criteria:

• Gestational age between 20w0d and 24w0d

• Twin pregnancy, diamniotic-dichorionic, both twins living

• Cervical length 10 mm to 25 mm discovered by a screening transvaginal ultrasound exam

Exclusion Criteria:

• Mother less than 18 years of age

• Uterine contractions of 40 seconds duration or more, 10 or more per hour

• Rupture of fetal membranes (leakage of amniotic fluid one or both sacs)

• Ongoing vaginal bleeding

• Any condition likely to cause serious neonatal morbidity independent of gestational age, including:

1. fetal malformation likely to require surgery

2. fetal malformation involving vital organs

3. fetal viral infection

4. hydrops fetalis

5. discordance in estimated fetal weight more than 10%

6. velamentous insertion of umbilical cord of either twin

7. placenta previa of either placenta

• Any contraindication to continuing the pregnancy

• Cervical cerclage in place or planned

• Any contraindication to vaginal micronized progesterone, including:

1. Known sensitivity to progesterone or any of the other ingredients

2. Liver dysfunction or disease

3. Known or suspected malignancy of breast or genital organs

4. Active thromboembolic disorder, or history of hormone-associated thromboembolic disorder

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Premature Birth

Intervention

Drug:
• Vaginal Progesterone gel.
Daily administration of Vaginal Progesterone gel in pregnant women with twins between the 20th week of pregnancy and the 34th week of pregnancy.

Procedure:
• fetal fibronectin swab.
Collection of quantatative fetal fibronectin swab one week after randomization into the trial for both arms. Randomziation occurs between 20 weeks - 24 weeks of gestation.

Drug:
• Placebo gel
weekly vaginal administration of the placebo gel from randomization until 34 weeks of gestation.

Locations

Country	Name	City	State
United States	Good Samaritan Hospital	San Jose	California

Sponsors (1)

Lead Sponsor	Collaborator
Obstetrix Medical Group

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Comparison of effectiveness of progesterone in women in highest 2 quartiles of quantitative fetal fibronectin (fFN) versus those in the lowest 2 quartiles of quantitative fFN.	A cervicovaginal swab for quantitative fetal fibronectin testing will be obtained at the first antenatal visit, approximately 1 week after enrollment. The results of this will be used to test a secondary hypothesis that fFN levels will identify a subgroup of participants who respond to progesterone treatment and another subgroup who do not.	from the 21st week of gestation until the 25 week of gestation	No
Primary	Birth of baby before 34 weeks of gestation	The primary outcome is defined as Early Preterm Birth, that is, birth before 34weeks of gestation. A birth at 33weeks 6days or earlier is considered to have the primary outcome. A birth at 34weeks 0days or later does not have the primary outcome. Births for any reason before 34weeks 0days are considered to have the primary outcome, whether they are "spontaneous" or not.	At the time of delivery	Yes
Secondary	Gestational age of baby at birth	measured of the average Gestational age of babies at birth.	measure at time of birth	Yes
Secondary	Rate of "spontaneous birth" before 34weeks of gestation	Rate of "spontaneous birth" before 34weeks of gestation. Spontaneous births are those whose underlying cause is judged to be due to preterm labor, prelabor rupture of membranes, or cervical insufficiency. (In contradistinction, "indicated" deliveries are those due to preeclampsia, fetal growth problems, fetal heart rate abnormalities, and other problems.)	from randomization to birth of the baby - up to 15 weeks	Yes
Secondary	Rate of composite neonatal morbidity	Composite morbidity is defined as any one or more of: stillbirth, neonatal death, infant death before hospital discharge, respiratory distress syndrome (RDS), intracranial hemorrhage (grade 3 or 4)(IVH), necrotizing enterocolitis (stage 2 or 3)(NEC), documented neonatal sepsis within 72 hr of birth, or periventricular leukomalacia (characteristic lesions in the subcortical white matter seen on cerebral imaging studies within 96 hrs of birth)(PVL).	measures from randomization to 60 days post delivery of the baby	Yes