Vaginal Progesterone to Prevent Preterm Delivery in Women With Preterm Labor

Overview

The administration of vaginal progesterone, in addition to standard tocolysis, will decrease the risk of delivering prematurely and of recurrent preterm labor. We also hypothesize that the reduction in preterm delivery will be associated with a decrease in infant mortality and morbidity.

Full Title of Study: “Prevention of Preterm Delivery With Vaginal Progesterone in Women With Preterm Labor”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Crossover Assignment
    • Primary Purpose: Prevention
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: December 2012

Detailed Description

The principal aim is to demonstrate that progesterone reduces preterm birth before 37 weeks of gestation. Secondary aims are to show that progesterone 1) reduces preterm birth before 32 and before 34 weeks of gestation 2) reduces the number and duration of recurring episodes of preterm labor and 3) reduces infant mortality and morbidity.

Interventions

  • Drug: progesterone
    • vaginal capsules containing 200 mg of natural progesterone, once a day, until 36 6/7 weeks of gestation or until preterm delivery (whichever occurs first).
  • Drug: placebo
    • vaginal capsules containing placebo, once a day, until 36 6/7 weeks of gestation or until preterm delivery (whichever occurs first).

Arms, Groups and Cohorts

  • Experimental: 1
  • Placebo Comparator: 2

Clinical Trial Outcome Measures

Primary Measures

  • The principal aim is to demonstrate that progesterone reduces preterm birth before 37 weeks of gestation
    • Time Frame: end of pregnancy

Secondary Measures

  • Secondary aims are to show that progesterone 1) reduces preterm birth before 32 and before 34 weeks of gestation 2) reduces the number and duration of recurring episodes of preterm labor and 3) reduces perinatal mortality and morbidity, 4)Side effects
    • Time Frame: end of pregnancy and 28 days after delivery

Participating in This Clinical Trial

Inclusion Criteria

  • Gestational age between 240/7 et 336/7 weeks of gestation (based on a reliable estimate by ultrasound performed before 22 weeks) – Singleton pregnancy – Intact membranes – Preterm labor defined as: – 2 or more regular and painful uterine contractions in 10 minutes plus one or plus of the following criteria: – short cervix detected by vaginal ultrasound scanning (cervical length less than 30 mm until 31 weeks and less than 25 mm from 32 weeks) – cervical changes detected clinically (cervical length less or equal 10 mm or Bishop score less than 6 – cervical changes during hospitalization (more or equal 5 mm between two clinical or US exams) – positive fetal fibronectin – Age ≥ 18 years old – Signed informed consent – Possible and accepted follow-up Exclusion Criteria:

  • Multiple gestation – Cervical cerclage – Hydramnios (AFI >95th percentile for gestational age or greatest pocket >8 cm) – Premature rupture of membranes – Chorioamnionitis (criteria for clinical diagnosis are: elevated WBC, elevated CRP, maternal tachycardia, fetal tachycardia, uterine tenderness and/or amniotic fluid foul odor) – Cervical dilatation > 3 cm – Placenta praevia or abruptio placentae – Intra-uterine growth restriction or non-reassuring fetal status – Pre-eclampsia or severe hypertension – Any other maternal or fetal pathology which should indicate medically preterm delivery

Gender Eligibility: Female

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • begoña Martinez de Tejada
  • Collaborator
    • Centre Hospitalier Universitaire Vaudois
  • Provider of Information About this Clinical Study
    • Sponsor-Investigator: begoña Martinez de Tejada, MD, PhD – University Hospital, Geneva
  • Overall Official(s)
    • Begona Martinez de Tejada, MD, PhD, Principal Investigator, University Hospital, Geneva

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