Focal Myometrial Contractions: Impact on Cervical Assessment and Association With Voiding

Overview

Focal myometrial (uterine) contractions occur in a substantial number of vaginal ultrasound examinations and can impede accurate cervical length measurement and placental location determination. The timing of bladder voiding is associated with the prevalence of focal myometrial contractions on vaginal ultrasound cervical assessment. We propose a blinded randomized-controlled trial of bladder voiding immediately before vaginal ultrasound for cervical assessment compared with no bladder voiding immediately before vaginal ultrasound in order to determine the prevalence of focal myometrial contractions during vaginal ultrasound cervical assessment and test whether timing of bladder voiding is associated with their incidence.

Full Title of Study: “Focal Myometrial Contractions: Impact on Cervical Assessment and Association With Voiding. A Randomized Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Single (Outcomes Assessor)
  • Study Primary Completion Date: June 2013

Detailed Description

This blinded randomized-controlled trial will be performed through the Division of Maternal Fetal Medicine at Beth Israel Deaconess Medical Center. We will offer enrollment to any pregnant woman at gestational weeks 14+0/7 through 31+6/7 presenting for obstetric ultrasound where cervical assessment and/or placental location determination is indicated. Patient positioning and image acquisition will follow a standard protocol and will be performed by the co-investigators. Outcome ascertainment will be performed by two co-investigators blinded to participant allocation upon completion of data collection. Demographic and obstetrical outcome data will be collected via review of the medical record. Analysis of primary and secondary outcomes will yield incidence data, and comparisons will be made between groups.

Interventions

  • Behavioral: Interval bladder emptying
    • Participants randomized to the “Interval” arm (cervical assessment 15 minutes or more after voiding) will be notified of their allocation and asked to immediately use the rest room and attempt to void completely. A synchronized clock will be located in this restroom, and each participant will be asked to note the time that she completes voiding. This will be confirmed by the research staff by noting the time the participant enters and exits the restroom. The participant will return to the waiting room or ultrasound room. Any indicated trans-abdominal ultrasound imaging will be performed, and preparations will be made for the vaginal ultrasound. The participant will be asked not to void prior to the vaginal ultrasound. Cervical assessment will take place at a minimum of 15 minutes from voiding time.

Arms, Groups and Cohorts

  • No Intervention: Immediate
    • Participants randomized to the “Immediate” or control arm (voiding within five minutes of cervical assessment), will undergo any indicated trans-abdominal ultrasound imaging and preparations for vaginal ultrasound (including readying the probe and preparing the exam table for lithotomy position) prior to using the restroom. The participant will be instructed to proceed to the restroom to empty her bladder completely. A synchronized clock will be placed in the restroom, and the patient will be asked to note the time that she completes voiding. This will be confirmed by the research staff by noting the time the participant enters and exits the restroom. Vaginal ultrasound and cervical assessment will then be performed immediately upon return to the ultrasound room (within a maximum of 5 minutes from voiding time).
  • Experimental: Interval
    • Participants randomized to the “Interval” or experimental arm (cervical assessment 15 minutes or more after voiding) will be notified of their allocation and asked to immediately use the rest room and attempt to void completely. A synchronized clock will be located in this restroom, and each participant will be asked to note the time that she completes voiding. This will be confirmed by the research staff by noting the time the participant enters and exits the restroom. The participant will return to the waiting room or ultrasound room. Any indicated trans-abdominal ultrasound imaging will be performed, and preparations will be made for the vaginal ultrasound. The participant will be asked not to void prior to the vaginal ultrasound. Cervical assessment will take place at a minimum of 15 minutes from voiding time

Clinical Trial Outcome Measures

Primary Measures

  • Presence of focal myometrial contraction
    • Time Frame: Throughout the duration of that ultrasound examination (minutes)
    • Focal myometrial contraction as defined by transvaginal ultrasound findings: Thickening of the myometrial portion of the uterine wall visualized as two distinctly different areas of echogenicity An unusually long-appearing cervix (possibly more than 50 mm) with an S-shaped endocervical canal and apparent internal os located appreciably cephalad Asymmetric anterior and posterior lower uterine segment widths cephalad to apparent internal os The thickening is transient.

Secondary Measures

  • Location of focal myometrial contractions
    • Time Frame: Throughout the duration of that ultrasound examination (minutes)
    • The location of focal myometrial contractions in relation to the internal cervical os is defined by: Distance from internal os to caudal-most portion of focal myometrial contraction (measured with a curved line).. Proportion that lie immediately adjacent to the internal cervical os.

Participating in This Clinical Trial

Inclusion Criteria

  • Gestational age of 14+0/7 through 31+6/7 weeks
  • Presenting for obstetric ultrasound in the MFMU for cervical assessment and/or placental location determination
  • Verbal consent
  • Ability to refrain from urination for at least 15 minutes
  • Age 18 years or greater

Exclusion Criteria

  • N/A

Gender Eligibility: Female

Minimum Age: 18 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Beth Israel Deaconess Medical Center
  • Provider of Information About this Clinical Study
    • Principal Investigator: William Schnettler, Fellow in Maternal Fetal Medicine, Instructor – Beth Israel Deaconess Medical Center
  • Overall Official(s)
    • Diana Rodriguez, MD, MPH, Principal Investigator, Beth Israel Deaconess Medical Center
  • Overall Contact(s)
    • William T Schnettler, MD, 513-290-0900, wschnett@bidmc.harvard.edu

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