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Labor InductionBALINCT04035382

BMI-Associated Labor Induction: A Prospective Trial

A study testing Labor induction in people with Labor Induction, run by Baystate Medical Center at 2 sites in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The primary objective of this study is to determine if planned induction of labor at 39 weeks for nulliparous with pre-pregnancy BMI ≥ 35 kg/m2 reduces the incidence of cesarean section compared to expectant management 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
Labor Induction
What is being tested?
Labor induction
Could I receive a placebo?
No, everyone receives an active treatment
How many people
82 participants
Where
2 sitesUnited States
Study dates
31 Oct 2019to 31 Dec 2022
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

  • Age 18 years and older
  • Pregnant, singleton gestation, vertex presentation
  • Nulliparous (no prior pregnancy delivered past 20 weeks)
  • Pre-pregnancy (self-reported in record of in EMR within 3 months of LMP) or 1st trimester (up to and including 14 weeks 0 days) BMI ≥ 35 kg/m2
  • Gestational age at enrollment 38 weeks 0 days and 38 weeks 6 days with dating confirmed by LMP and ultrasound performed prior to 20 6/7 weeks

Who cannot join

  • Plan for induction of labor prior to 41 weeks 0 days for medical indication prior to study consideration
  • Plan for cesarean delivery or contraindication to labor
  • Major illness with increased risk of adverse pregnancy outcomes (e.g. pregestational diabetes with or without medication, gestational diabetes on medication, hypertension, cardiac disease, renal insufficiency, autoimmune disorder)
  • Multiple gestation
  • Non-vertex presentation
  • Fetal death
Show all 20Show fewer
  • Fetus with major/lethal anomaly or aneuploidy (soft markers of aneuploidy, urinary tract dilation, isolated bowel dilation, mild ventriculomegaly, normal variants of vascular system, and isolated ventricular septal defects will not be excluded)
  • Soft markers not qualifying as exclusion criteria: echogenic intracardiac focus, choroid plexus cyst, echogenic bowel, increased NT or nuchal fold, isolate short humerus or femur
  • Fetal growth restriction (EFW <10th percentile or AC <10th percentile)
  • Preeclampsia or gestational hypertension
  • Known oligohydramnios or polyhydramnios
  • Prior delivery after 20 weeks
  • Placenta/vasa previa
  • Placental abruption (known or suspected) or unexplained vaginal bleeding
  • Previous cesarean section, myomectomy, or classical cesarean
  • Spontaneous labor or suspicion of labor with regular contractions and cervical change, rupture membranes
  • Active genital herpes or HIV positive
  • Inability to consent
  • Any contraindication to a vaginal delivery
  • Delivery anticipated outside of Baystate Medical Center

Trial locations and contacts

2 sites in 1 country.

United States2 sites, 2 recruiting
  • Sidney Kimmel Medical College, Thomas Jefferson University

    Philadelphia, Pennsylvania, 19107

    Rupsa Boelig, MD, 215-995-9196, rupsa.boelig@jefferson.edu

    Rupsa Boelig, MD

    Recruiting
  • Baystate Medical Center

    Springfield, Massachusetts, 01199

    Corina Schoen, MD, 413-794-2470, Corina.SchoenMD@baystatehealth.org

    Laura Gebhardt, BA, CCRP, 413-794-2706, laura.gebhardt@baystatehealth.org

    Recruiting

Other trials in United States

About this study

The primary objective of this study is to determine if planned induction of labor at 39 weeks for nulliparous with pre-pregnancy BMI ≥ 35 kg/m2 reduces the incidence of cesarean section compared to expectant management

Read the detailed description

Obesity in the obstetric population has reached epidemic proportions, affecting over 30% of reproductive-aged women in the United States (1). The increase in this morbidity is associated with large increases in cesarean delivery over the non-obese obstetric population and resultant post-operative complications are also higher in obese women (2). There are no interventions proven to reduce the risk of cesarean in obese women. The aim of this research study is to determine if induction of labor at 39 weeks can reduce the incidence of cesarean delivery over routine obstetric care (expectant management).

Conditions
Labor Induction
Being tested
Labor induction
Keywords
BMI, Obesity, Labor induction, Cesarean section
Medical subject headings
Obesity

What participants receive

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

  • Labor inductionProcedure or surgery

    Also called Foley catheter, Misoprostol, Oxytocin, Amniotomy

    The study intervention is labor induction from 39 0/7 to 39 6/7 weeks. The individual labor induction process will be at the discretion of the physician or midwife managing the subject's care. Methods of induction that may be used include misoprostol, intracervical Foley catheter, oxytocin, and/or amniotomy. Participating clinicians will be encouraged to use only one course of cervical ripening followed by oxytocin infusion and amniotomy.

Study groups in NCT04035382
Study groupRoleWhat they receive
Labor InductionExperimentalInduction of labor between 39 0/7 to 39 6/7 weeks. Cervical ripening and induction method will be left to the managing clinician. However, combination method of cervical ripening with prostaglandin or oxytocin and Foley catheter, followed by oxytocin infusion and amniotomy will be encouraged.
Receives: Procedure: Labor induction

What is being measured

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

  1. Incidence of cesarean section

    The primary outcome is to determine whether planned induction of labor at 39 weeks for obese nulliparous women changes the incidence of cesarean section.

    Measured: Admission for induction to discharge from delivery admission, up to 3 weeks after enrollment.

Secondary outcomes (43)
  1. Incisional extensions at cesarean section

    J or T shape incisions or cervical trauma

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  2. Operative vaginal delivery and indication

    Vacuum or forceps

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  3. Suspected intraamniotic infection

    At least one maternal fever ≥100.4 F with at least one additional clinical sign of maternal tachycardia, fetal tachycardia, uterine tenderness or purulent/foul smelling vaginal discharge

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  4. 3rd or 4th degree perineal laceration

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  5. Maternal death

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  6. Antepartum, intrapartum, or neonatal death

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  7. Admission to the intensive care unit (ICU)

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  8. Preeclampsia

    Preeclampsia without severe features: Elevated blood pressure after 20 weeks ≥140/90 on 2 occasions at least 4 hours apart with previously normal blood pressure AND,

    • proteinuria (≥300 mg per 24 hours collection OR ≥0.3 mg/dL on protein:creatinine ratio OR 1+ on dipstick if neither of the previous is available)

    Preeclampsia with severe features: Elevated blood pressure after 20 weeks ≥160/110 on 2 occasions (may be within minutes to ensure medication treatment) OR,

    • Blood pressure ≥140/90 and systemic findings including: new platelet count <100,000microliter, serum creatinine >1.1 mg/dL, doubling of serum creatinine in absence of other renal disease, liver transaminases twice upper limit of normal, pulmonary edema, cerebral or visual symptoms
    • Proteinuria is not necessary for this diagnosis

    Eclampsia: preeclampsia with eclamptic seizure

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  9. Gestational hypertension

    Gestational hypertension: blood pressure elevation ≥140/90 on two occasions after 20 weeks in absence of proteinuria or systemic findings defined above

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  10. Postpartum hemorrhage

    Visual estimated blood loss >1000 mL or need for two or more uterotonics

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  11. Postpartum endometritis

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  12. Composite maternal infectious outcome

    Endometritis, wound reopened for hematoma, seroma, infection, or other reasons, cellulitis requiring antibiotics, pneumonia, pyelonephritis, bacteremia of unknown source, septic pelvic thrombosis

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  13. Maternal venous thromboembolism

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  14. Birth weight

    Macrosomia >4500 grams, large for gestational age (LGA) defined as 90th percentile weight for gestational age, assessed specifically by sex and race of the infant based on United States birth certificate data

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  15. Duration and presence (up to 72 hours) of respiratory support

    Including ventilator, CPAP, high-flow nasal cannula (HFNC)

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  16. Small for gestational age

    <5th percentile and <10th percentile weight for gestational age, assessed specifically by sex and race of the infant based on United States birth certificate data

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  17. Cephalohematoma

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  18. Shoulder dystocia

    Need for additional maneuvers to accomplish delivery

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  19. Transfusion of blood products

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  20. Breastfeeding intention and initiation in the hospital

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  21. Breastfeeding at 6 weeks (exclusive and any breastfeeding)

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  22. Hyperbilirubinemia requiring phototherapy or exchange transfusion

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  23. Apgar ≤ 7 at 5 minutes

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  24. Neonatal seizures

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  25. Sepsis

    Requires the presence of a clinically ill infant in whom systemic infection is suspected with a positive blood, cerebrospinal fluid (CSF), or catheterized/suprapubic urine culture; or, in the absence of positive cultures, clinical evidence of cardiovascular collapse or an unequivocal X-ray confirming infection.

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  26. Neonatal encephalopathy

    As defined by Shankaran et al.

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  27. Meconium aspiration syndrome

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  28. Birth trauma

    Bone fractures, brachial plexus palsy, other neurologic injury, retinal hemorrhage facial nerve injury

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  29. Intracranial hemorrhage or subgaleal hemorrhage

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  30. Neonatal hypotension requiring pressor support

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  31. Neonatal composite outcome

    IUFD, neonatal death, intubation or neonatal respiratory support, Apgar score ≤ 7 at 5 minutes, seizures, sepsis as defined above, neonatal encephalopathy, pneumonia, meconium aspiration syndrome, birth trauma, intracranial hemorrhage, or hypotension

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  32. Hypoglycemia

    glucose < 35 mg/dL requiring IV therapy

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  33. Admission to the neonatal intensive care unit (NICU)

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  34. Number of clinic visits post enrollment to admission for delivery

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  35. Non-stress tests, biophysical profiles (BPP), modified BPPs, ultrasounds done other than BPP, Doppler, contraction stress test

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  36. Intrauterine pressure catheter (IUPC) or fetal scalp electrode placement

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  37. Epidural use

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  38. Use of induction and ripening agents, maximum dose of oxytocin

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  39. Number of hours on labor and delivery unit

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  40. Maternal postpartum length of hospital stay

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  41. Neonatal length of hospital stay

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  42. Length of NICU or intermediate care stay

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

  43. Post discharge resource utilization

    Inpatient and outpatient visits for mother and baby from discharge to 6 weeks

    Measured: From enrollment to 6-8 weeks postpartum, average of 10 weeks after enrollment.

Timeline

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

  1. First posted29 Jul 2019
  2. Study start31 Oct 2019
  3. Primary completion30 Sep 2022 (estimated)
  4. Study completion31 Dec 2022 (estimated)

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
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Simon two-stage
Masking
None (open label)
Enrolment
82 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04035382
Sponsor's protocol ID
BH-19-000
Acronym
BALI
Status last verified
Apr 2022
First submitted
16 Jul 2019
Last updated
13 Apr 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Labor induction in people with Labor Induction, run by Baystate Medical Center at 2 sites 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 5 inclusion and 20 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: status not confirmed, as of the sponsor's last update on 13 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites 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?

Results are not available in the source record.

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

Contact Corina Schoen, MD (413-794-3470, Corina.SchoenMD@baystatehealth.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of cesarean section (time frame: Admission for induction to discharge from delivery admission, up to 3 weeks after enrollment.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 13 Apr 2022.

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