AzTrials
AzTrials

Preterm BirthNCT03151330

Serum Assessment of Preterm Birth Outcomes Compared to Historical Controls: AVERT PRETERM TRIAL

A study testing Screened Arm in people with Preterm Birth, run by Christiana Care Health Services at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Recently treatments early in pregnancy such as progesterone, cervical support and maternal support have been demonstrated to delay delivery amongst at risk women. Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
Conditions the study is for
Preterm Birth
What is being tested?
Screened Arm
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,873 participants
Where
1 siteUnited States
Study dates
15 Jun 2018to 1 Jun 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Women 18 years of age or older
  • Singleton intrauterine pregnancy
  • No medical contraindications to continuing pregnancy
  • Subject has no signs and/or symptoms of preterm labor and has intact membranes
  • Planned delivery at Christiana Care Health System,
  • English speaking as consents from other languages will not be provided.

Who cannot join

  • Women who have taken or plan to take progesterone beyond 14weeks gestation prior to study enrollment
  • Previous history of sPTB less than37 weeks gestation or PPROM less than34 weeks gestation
  • Multiple gestations-including a pregnancy that is now a single fetus due to a reduction procedure, vanishing twin, etc
  • Known fetal genetic anomalies that are incompatible with life. Examples would include trisomy 13 and trisomy 18. Others would be left to the discretion of the site investigators
  • Any other medical conditions that may be considered a contraindication per the judgment of the site investigator
  • The subject has a planned cesarean section or induction of labor prior to 370/7 weeks of gestation
Show all 14Show fewer
  • The subject has a planned cerclage placement for the current pregnancy
  • Major structural anomalies that may shorten pregnancy- examples would include anencephaly, holoprosencephaly, schizencephaly, gastroschisis, omphalocele, congenital diaphragmatic hernia, pyloric stenosis, etc. Minor anomalies such as polydactyly, unilateral hydronephrosis are not viewed as exclusions. Others would be left to the discretion of the site investigators
  • History of cervical conization
  • The subject has a uterine anomaly, History of classical cesarean section in a previous pregnancy
  • The subject has had a blood transfusion during the current pregnancy
  • The subject has known elevated bilirubin levels (hyperbilirubinemia)
  • Previously identified short cervix (< 2.5 cm by TVUS)
  • The subject has taken or plans to take any of the following medications after the first day of the last menstrual period: Enoxaparin, heparin, heparin sodium, low molecular weight heparin or the subject has a history of allergic reaction to aspirin or progesterone.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Christiana Hospital

    Newark, Delaware, 19718

Other trials in United States

About this study

Official title: Serum Assessment of Preterm Birth: Outcomes Compared to Historical Controls

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Recently treatments early in pregnancy such as progesterone, cervical support and maternal support have been demonstrated to delay delivery amongst at risk women. Nonetheless, the majority of women who are at risk are not identified using current screening modalities.

Hypothesis: A cohort of pregnancies who are screened using the PreTRM® test around 20 weeks gestation in which a bundle of interventions is given for elevated PreTRM® risk will show either decreased neonatal morbidity/and mortality (measured as a composite score, "NMI"), or decreased length of neonatal stay in the hospital (NNOLOS). Secondarily, they will show an increase in gestational age at birth (GAB) and a reduction in length of neonatal NICU stay (NICULOS), compared to an unscreened historical control group.

Study Design Type: Prospective cohort study of screened women compared to a historical control of 10000 women.

Read the detailed description

Population: Women who are 18 years or older, with a singleton pregnancy between 195/7 weeks and 206/7 weeks gestational age (GA) confirmed by ultrasound prior to enrollment, and no history of prior preterm birth (delivery between 160/7 weeks and 366/7 weeks) will be invited to participate. A comparable population will be identified using a historical control group in a contemporaneously maintained database.

Intervention: Qualifying women will be screened using the PreTRM® test (Sera Prognostics, Inc.) at a large tertiary care center. Predicated upon the degree of risk, women will be treated according to a prespecified algorithm. The outcomes of these women will be compared to a historical control group at the same tertiary care center.

Outcomes:

Primary outcome: Co-Primary outcomes: To determine whether a cohort of women who are screened with the PreTRM® test and then managed according to a prespecified protocol will have statistically significant reductions in either (a) composite neonatal morbidity and mortality (NMI score), or (b) length of neonatal hospital stay (NNOLOS), compared to a historical control group. The NMI is defined below

DEFINITIONS OF COMPOSITE PERINATAL MORTALITY/NEONATAL MORBIDITY OUTCOME SCORES:

  1. 0 to 4 scale without NICU: This score was derived as an ordinal scale based upon severity. The score was defined by the following: 0 = no events;
  2. = one event for (RDS, BPD, grade III or IV IVH, PVL, proven sepsis, or NEC) and no perinatal mortality,
  3. = two events and no perinatal mortality;
  4. = three or more events and no perinatal mortality; 4=perinatal mortality.
  5. 0 to 4 scale with NICU: This score was defined as the following: 0 = no events,
  6. = one event for (RDS, BPD, grade III or IV IVH, PVL, proven sepsis, or NEC) or <5 days in the NICU, and no perinatal mortality;
  7. = two events or between 5 and 20 days in the NICU, and no perinatal mortality;
  8. = three or more events or >20 days in the NICU, and no perinatal mortality;
  9. = perinatal mortality.
  10. 0 to 6 scale without NICU: This score was defined as the following: 0 = no events;
  11. = one event for (RDS, BPD, grade III or IV IVH, proven sepsis, or NEC) and no perinatal mortality,
  12. = two events and no perinatal mortality;
  13. = three events and no perinatal mortality;
  14. = four events and no perinatal mortality;
  15. = five events and no perinatal mortality;
  16. = perinatal mortality.
  17. Any morbidity or mortality event: (yes/no)
  • Adapted from Hassan SS, et al. Ultrasound Obstet Gynecol 2011; 38:18-31 Supplementary Information

Secondary outcomes: To determine whether women who are screened with the PreTRM® test and then managed according to a pre-specified treatment algorithm will have a statistically significant reduction in proportion of any type of preterm births (spontaneous and indicated), the total length of hospital stay for spontaneous preterm births, and total length of hospital stay for any preterm birth.

Observations:

  • Neonatal death and stillbirth
  • Birth weight and number of subjects with birth weight <1500g and <2500g
  • Total number of days spent in the NICU and nursery
  • Composite neonatal morbidity score and components
  • Whether or not received surfactant
  • Occurrence of pneumonia
  • Number of days of mechanical ventilation
  • Number of subjects with 5 minute Apgar < 7
  • Occurrence of asphyxia
  • Number of preterm deliveries at <37, <35 and <32 weeks
  • Occurrence of preeclampsia
  • Proportion of primiparous women experiencing preterm birth and spontaneous preterm birth
  • NICU days for spontaneous preterm birth in primiparous women in prospective treatment arm are significantly less than NICU days in primiparous women in the control group of sPTB
  • Correlation of blood levels of 17-OHPC and other progestin levels to outcomes and observations

General Outcomes:

Total cost of hospital care for both the mother and fetus beginning at initiation of care through primary delivery and 28 days of life.

Conditions
Preterm Birth
Being tested
Screened Arm
Medical subject headings
Premature Birth

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Screened ArmOther

    Woman who are identified as high risk will be advised of potential interventions which will include support through care link(nurse education), cervical surveillance, consider vaginal progesterone, low dose aspirin if not already taking.

Study groups in NCT03151330
Study groupRoleWhat they receive
Screened armOtherThis will be an arm of women who are prospectively screened and receive a risk score for preterm birth. They will be recommended treatment strategies and their outcomes compared to an historical control.
Receives: Other: Screened Arm

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Neonatal Mortality Index

    Outcomes:

    Co primary outcomes will consist of the Neonatal Morbidity Index as defined by Hassan and Neonatal NICU length of stay

    Measured: Birth through 6 months

  2. Neonatal NICU length of stay

    Duration of hospitalization in the NICU

    Measured: Birth to 6 months

Secondary outcomes (2)
  1. Preterm birth

    Preterm birth before 37 weeks

    Measured: Through pregnancy completion, typically 42 weeks

  2. Total length of hospital stay for any preterm birth

    Total length of hospital stay for any preterm birth

    Measured: From birth to 60 days post delivery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 May 2017
  2. Study start15 Jun 2018
  3. Primary completion16 Mar 2020
  4. Study completion1 Jun 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Not applicable
Intervention model
Single group
Model description
Women who are found to have an elevated risk of preterm birth will receive counseling regarding potential interventions and compared to historical controls
Masking
None (open label)
Enrolment
1,873 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03151330
Sponsor's protocol ID
DDD603819
Status last verified
Aug 2024
First submitted
22 Apr 2017
Last updated
5 Aug 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: IPD will potentially be shared with a like study being conducted at the University of Utah

Publications

  • Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep. 2003 Nov 7;52(9):1-85.

    PubMed 14626726
  • Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis. Obstet Gynecol. 2011 Mar;117(3):663-671. doi: 10.1097/AOG.0b013e31820ca847.

    PubMed 21446209
  • CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group. Lancet. 1994 Mar 12;343(8898):619-29.

    PubMed 7906809
  • Esplin MS, Elovitz MA, Iams JD, Parker CB, Wapner RJ, Grobman WA, Simhan HN, Wing DA, Haas DM, Silver RM, Hoffman MK, Peaceman AM, Caritis SN, Parry S, Wadhwa P, Foroud T, Mercer BM, Hunter SM, Saade GR, Reddy UM; nuMoM2b Network. Predictive Accuracy of Serial Transvaginal Cervical Lengths and Quantitative Vaginal Fetal Fibronectin Levels for Spontaneous Preterm Birth Among Nulliparous Women. JAMA. 2017 Mar 14;317(10):1047-1056. doi: 10.1001/jama.2017.1373.

    PubMed 28291893
  • Rittenberg C, Newman RB, Istwan NB, Rhea DJ, Stanziano GJ. Preterm birth prevention by 17 alpha-hydroxyprogesterone caproate vs. daily nursing surveillance. J Reprod Med. 2009 Feb;54(2):47-52.

    PubMed 19301566
  • Saade GR, Boggess KA, Sullivan SA, Markenson GR, Iams JD, Coonrod DV, Pereira LM, Esplin MS, Cousins LM, Lam GK, Hoffman MK, Severinsen RD, Pugmire T, Flick JS, Fox AC, Lueth AJ, Rust SR, Mazzola E, Hsu C, Dufford MT, Bradford CL, Ichetovkin IE, Fleischer TC, Polpitiya AD, Critchfield GC, Kearney PE, Boniface JJ, Hickok DE. Development and validation of a spontaneous preterm delivery predictor in asymptomatic women. Am J Obstet Gynecol. 2016 May;214(5):633.e1-633.e24. doi: 10.1016/j.ajog.2016.02.001. Epub 2016 Feb 11.

    PubMed 26874297
  • Romero R, Conde-Agudelo A, El-Refaie W, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Abdelhafez MS, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol. 2017 Mar;49(3):303-314. doi: 10.1002/uog.17397.

    PubMed 28067007

Questions about this trial

What is this clinical trial studying?

A study testing Screened Arm in people with Preterm Birth, run by Christiana Care Health Services at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Aug 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Neonatal Mortality Index (time frame: Birth through 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03151330, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Aug 2024.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in