Cervical Cerclage for Twin Pregnancy With Sonographic Cervical Length 0.1 to 15.0 mm: A Randomized Clinical Trial
Overview
- Phase
- Phase 2
- Intervention
- Cervical Cerclage placement
- Conditions
- Preterm Birth
- Sponsor
- Pediatrix
- Primary Endpoint
- Rate of very preterm birth (PTB)
- Status
- Withdrawn
- Last Updated
- 8 years ago
Overview
Brief Summary
A prospective randomized control trial that will compare cervical cerclage plus vaginal progesterone to vaginal progesterone along in twin pregnancies complicate by a short cervix (</= 15.0mm) between 16w0d to 25w6d.
Detailed Description
A prospective Randomized Trial that will test whether treatment with cervical cerclage plus vaginal progesterone improves pregnancy outcomes among women with twin pregnancy at 16 0/7 to 25 6/7 weeks of gestation who have a cervical length (CL) of 0.1 to 15.0 mm on transvaginal ultrasound exam, the rate of preterm birth at less than 32 weeks of gestation (PTB\<32 wks.) and the rate of adverse perinatal outcome will be lower in those treated with cervical cerclage plus vaginal progesterone than in those treated with vaginal progesterone alone.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Twin pregnancy (see Exclusion Criterion (a) below re: monochorionic twins)
- •Gestational age 16 0/7 to 25 6/7 weeks at time of enrollment by best-estimated age.
- •Cervical length 0.1 to 15.0 mm on transvaginal ultrasound examination. (Cervical length is taken to mean the length of the closed portion of the cervical canal.
Exclusion Criteria
- •Maternal age less than 18 years
- •Monochorionic twins (such as monochorionic-diamniotic, monochorionic-monoamniotic, or conjoined twins)
- •Rupture of membranes, either twin
- •One or both twins has no cardiac activity
- •One or both twins has known or suspected major malformation, aneuploidy, or polyhydramnios
- •Maternal congenital uterine anomaly (such as bicornuate uterus, unicornuate uterus)
- •Pregnancy started as triplets or higher-order multifetal gestation and then reduced to twins, either spontaneously or via procedure
- •Symptomatic uterine contractions, 6 or more per hour
- •Ongoing bleeding from uterus
- •Patient declines to consider cerclage
Arms & Interventions
Cervical Cerclage + Progesterone
Placement of a Cervical Cerclage plus the daily administration of vaginal progesterone (200mg tab)
Intervention: Cervical Cerclage placement
Cervical Cerclage + Progesterone
Placement of a Cervical Cerclage plus the daily administration of vaginal progesterone (200mg tab)
Intervention: Vaginal Progesterone
Progesterone
Daily administration of vaginal progesterone (200mg tab)
Intervention: Vaginal Progesterone
Outcomes
Primary Outcomes
Rate of very preterm birth (PTB)
Time Frame: Time frame measured on the date the infant is born. We anticipate this time frame to be approximately 16 weeks.
Rate of very PTB (PTB less than 32 weeks)
Rate of adverse perinatal outcome
Time Frame: Time frame measured 28 days after the infant is born. We anticipate this time frame to be approximately 28 weeks.
The rate of adverse perinatal outcome defined as any one or more of the following: Miscarriage, stillbirth, neonatal death, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage (grade III or IV), necrotizing enterocolitis, culture proven sepsis.