AzTrials
AzTrials

Pregnancy, ProlongedMILONCT04307199

Membrane Sweeping to Prevent Post-term Pregnancy: The MILO Study

A study testing Amniotic membrane sweep in people with Pregnancy, Prolonged and Induced; Birth, run by National University of Ireland, Galway, Ireland.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Trial summary

Multicentre, pragmatic, parallel group, pilot randomised controlled trial with an embedded factorial design. Read more about this study

Who is it for?
Ages 18 years and older, women onlyHealthy volunteers can take part
What is being tested?
Amniotic membrane sweep
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
132 participants
Where
No sites listed yet
Study dates
30 Jul 2020to 30 Dec 2021
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

  • Pregnant women carrying a live singleton fetus ≥ 38 weeks completed gestation.
  • (Gestational age will be calculated from the first day of the last menstrual period and an
  • ultrasound examination carried out in the 2nd trimester)
  • Longitudinal lie
  • Cephalic presentation
  • Intact amniotic
  • ≥ 18 years of age on enrollment

Who cannot join

  • Not able to communicate in english
  • contraindications to a vaginal examination
  • contraindications to a vaginal birth

Trial locations and contacts

No sites are listed yet.

About this study

Official title: Feasibility Study Protocol of a Pragmatic, Randomised Controlled Pilot Trial: Membrane Sweeping to Prevent Post-term Pregnancy: The MILO Study

Multicentre, pragmatic, parallel group, pilot randomised controlled trial with an embedded factorial design.

Read the detailed description

The primary aim of the MILO study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. We will also assess the acceptability and feasibility of the proposed trial interventions to clinicians and women (through focus group interviews).

Methods/Design

Multicentre, pragmatic, parallel group, pilot randomised controlled trial with an embedded factorial design. Pregnant women with a live, singleton fetus ≥ 38 weeks gestation, cephalic presentation, longitudinal lie, intact membranes, English speaking and ≥18 years of age will be randomised in a 2:1 ratio to:

  • Membrane sweep versus no membrane sweep

Women allocated randomly to a sweep will then be randomised further (factorial component) to:

  • early (from 39 weeks) versus late (from 40 weeks) sweep commencement; and
  • a single verses weekly sweep

The proposed feasibility study consists of four work packages i.e., (1) a multicentre, pilot randomised trial, 2) a health economic analysis and 3) a qualitative study (4) a study within the host trial (a SWAT).

Being tested
Amniotic membrane sweep
Keywords
membrane sweep, feasibility study, randomised trial, pilot study, SWAT, pregnancy, induction of labour, post dates, prolonged pregnancy
Medical subject headings
Pregnancy, Prolonged

What participants receive

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

  • Amniotic membrane sweepProcedure or surgery

    Amniotic membrane sweeping is defined as the manual detachment of the inferior pole of the amniotic membranes from the lower uterine segment. This is performed with consent by a clinician digitally through a circular motion during a vaginal examination. If the cervical os is closed massage of the cervix will be accepted.

Study groups in NCT04307199
Study groupRoleWhat they receive
Group AExperimentalMembrane sweep @ 39 weeks' gestation only
Receives: Procedure: Amniotic membrane sweep
Group BExperimentalMembrane sweep @ 40 weeks' gestation only
Receives: Procedure: Amniotic membrane sweep
Group CExperimentalMembrane sweep @ 39, 40 and 41 weeks' gestation or until onset of labour
Receives: Procedure: Amniotic membrane sweep
Group DExperimentalMembrane sweep @ 40 and 41 weeks' gestation or until onset of labour
Receives: Procedure: Amniotic membrane sweep
Control GroupNo interventionWomen in the control arm will not receive a membrane sweep and will receive usual care (as defined by local hospital protocols and vaginal examination to determine Bishop score only).

What is being measured

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

  1. Recruitment

    Evaluation of the number and percentage of eligible women who are recruited and randomised to the study. Assessed by study-specific checklists.

    Measured: Duration of the recruitment process (approximately 8 months )

  2. Retention

    Evaluation of the number and percentage of eligible women who are randomised, take part in and adhere to the study protocols. Data will be extracted from routinely collected data.

    Measured: At month 15 approximately

  3. Adherence with the trial interventions.

    Evaluation of adherence with the trial interventions, and reasons for non-compliance assessed by study-specific checklists. Data will be extracted from routinely collected data and focus group interviews with clinicians and participants at six weeks post intervention.

    Measured: At month 15 approximately

  4. Evaluation of the randomisation process.

    Evaluation of effective allocation of participants to the intervention/control group assessed by study-specific checklists and evaluation of the randomisation protocol throughout the randomisation period.

    Measured: At month 15 approximately

  5. Evaluation of attrition rates

    Evaluation of attrition rates assessed by study-specific checklists. Data will be extracted from routinely collected data.

    Measured: At month 15 approximately

  6. Evaluation of the types of attrition

    Evaluation of the types of attrition assessed by case report forms. Data will be extracted from routinely collected data.

    Measured: At month 21 approximately

  7. Evaluation of the data collection process through study specific checklists

    Evaluated, statistically and narratively, by assessing the completeness of outcome measurements at baseline and postnatal (6 weeks) through study specific checklists. Researchers will manually examine the data collected. They will assess the proportion of complete data collection forms, the quality of data collected and the applicability of this data in facilitating pilot trial outcomes.

    Measured: At month 21 approximately

  8. Estimate the main effect of individual intervention components and their interactions

    Estimates (with measures of uncertainty) of the main effect of individual intervention components and any interaction effect between the main effects of the embedded factorial design will be assessed and reported using regression analysis.

    Measured: At month 21 approximately

  9. Evaluation of the data analysis process

    As this is a feasibility study formal hypothesis testing will not be undertaken. Researchers will manually examine the data collected. Evaluation of the data analysis process will be undertaken through the assessment of gaps and limitations to the analysis process measured by study-specific checklist. Findings will be reported through descriptive statistics and graphical summaries.

    Measured: At month 21 approximately

  10. Evaluation of the EQ5D

    Assessment of the mechanism of, timing of and delivery of the EQ5D through study specific checklists.

    Measured: At month 21 approximately

  11. Feasibility of cost analyses process through analysis of study specific documentation.

    Assessment of data collection tools to undertake cost effectiveness analysis through study specific documentation. Researchers will manually examine data to assess the mechanism of, timing of and delivery of the cost analysis tools.

    Measured: At month 21 approximately

  12. Feasibility of the cost effectiveness analyses

    Assessment of the mechanism and utilisation of the incremental cost-effectiveness ratio (ICER), through study specific checklists.

    Measured: At month 21 approximately

Secondary outcomes (24)
  1. Number of participants achieving a spontaneous onset of labour

    Labour which begins spontaneously.

    Measured: From time of randomisation to commencement of spontaneous onset of labour or formal induction of labour or caesarean section (up to 5 weeks)

  2. Number of participants who underwent an induction of labour

    Formal induction of labour using pharmacological or surgical methods.

    Measured: From time of randomisation to commencement of formal induction of labour (up to 5 weeks).

  3. Number of participants achieving a spontaneous vaginal birth

    Spontaneous vaginal birth

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  4. Instrumental birth

    Vaginal birth which is assisted with the use of instruments.

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  5. Caesarean Section

    Birth which is achieved through the surgical procedure caesarean section.

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  6. Post-Partum Haemorrhage ≥ 500mls

    Blood loss ≥ 500mls within the first 24 hours of the birth of a baby

    Measured: From time of birth to 24 hours after the birth of baby.

  7. Antepartum haemorrhage requiring hospital admission

    Bleeding from the genital tract, from 24+0 weeks of pregnancy and before the birth of the baby.

    Measured: From 24+0 weeks of pregnancy to birth of baby (up to 18 weeks)

  8. Uterine hyperstimulation with/without fetal heart rate (FHR) changes

    Uterine hyperstimulation defined as uterine tachysystole (more than five contractions per ten minutes for at least twenty minutes) and uterine hypersystole/hypertonicity (a contraction lasting at least two minutes). These may or not be associated with changes in the fetal heart rate pattern (persistent decelerations, tachycardia or decreased short term variability.

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  9. Serious maternal death or morbidity

    Serious maternal death or morbidity (e.g. uterine rupture, admission to intensive care unit, septicaemia)

    Measured: From time of randomisation to six weeks postnatal (up to 11 weeks).

  10. Epidural analgesia

    Introduction of a local anaesthetic into the epidural space of the vertebral canal.

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  11. Augmentation of labour

    The stimulation of uterine contractions using pharmacologic methods or artificial rupture of membranes to increase their frequency and/or strength following the onset of spontaneous labor or contractions following spontaneous rupture of membranes (ACOG 2014)

    Measured: From commencement of established labour to birth of baby (up to 2 days)

  12. Pyrexia in labour

    Pyrexia that developed anytime after onset of labour.

    Measured: From commencement of established labour to birth of baby (up to 2 days)

  13. Uterine rupture

    All clinically significant ruptures of unscarred or scarred uteri. Trivial scar dehiscence noted incidentally at the time of surgery will be excluded

    Measured: From time of randomisation to birth of baby (up to 5 weeks)

  14. EQ5D-5L

    EuroQol EQ5D-5L survey instrument.

    Measured: From time of randomisation to six weeks postnatal (up to 11 weeks)

  15. Serious neonatal morbidity

    e.g. seizures, birth asphyxia defined by trialists, neonatal encephalopathy, disability in childhood, Proven and suspected neonatal sepsis

    Measured: From time of birth of baby to six weeks postnatal.

  16. Apgar score < 7 at five minutes.

    The Apgar score provides an accepted and convenient method for reporting the status of the newborn infant immediately after birth and the response to resuscitation if needed (ACOG 2015).

    Measured: From birth of baby to five minutes of life.

  17. Cord PH < 7.20

    Umbilical cord blood gas test.

    Measured: From birth of infant to collection of cord bloods after delivery of the placenta (an average of 15 minutes)

  18. Neonatal encephalopathy

    Severity of hypoxic ischaemic encephalopathy assessed using Sarnat staging; i)Stage 1 (mild): hyper-alertness, hyper-reflexia, dilated pupils, tachycardia, absence of seizures; ii)Stage 2 (moderate): lethargy, hyper-reflexia, miosis, bradycardia, seizures, hypotonia with weak suck and Moro reflexes; iii)Stage 3 (severe): stupor, flaccidity, small to mid-position pupils which react poorly to light, decreased stretch reflexes, hypothermia and absent Moro reflex.

    Measured: From time of birth to six weeks postnatal.

  19. Perinatal death

    The perinatal period is defined as "commences at 22 completed weeks (154 days) of gestation and ends seven completed days after birth of baby."

    Measured: From time of randomisation to seven completed days after birth of baby (up to 6 weeks)

  20. Admission to neonatal intensive care unit or equivalent

    Admission of infant to neonatal intensive care unit or equivalent

    Measured: From time of birth to six weeks postnatal.

  21. Length of time from membrane sweep to birth of baby.

    Length of time from membrane sweep to birth of baby .

    Measured: From time of membrane sweep to birth of baby (up to 4 weeks)

  22. Length of time from formal induction of labour to birth of baby.

    Length of time from formal induction of labour to birth of baby.

    Measured: From time of formal induction of labour to birth of baby (up to 2 weeks)

  23. Overall length of maternal hospital stay

    Overall length of maternal hospital stay

    Measured: From time of randomisation to six weeks postnatal (up to 11 weeks).

  24. Length of infant stay in neonatal intensive care unit or equivalent

    Length of infant stay in neonatal intensive care unit or equivalent

    Measured: From time of birth to six weeks postnatal.

Timeline

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

  1. First posted13 Mar 2020
  2. Study start30 Jul 2020 (estimated)
  3. Primary completion30 Mar 2021 (estimated)
  4. Study completion30 Dec 2021 (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
Randomised
Intervention model
Factorial
Model description
Women will initially be randomised in a 2:1 ratio to: • Membrane sweep (2) versus no membrane sweep (1). Those allocated to the intervention group will then be further randomised in a factorial fashion to A, B, C or D: A. Membrane sweep @ 39 weeks' gestation only B. Membrane sweep @ 40 weeks' gestation only C. Membrane sweep @ 39, 40 and 41 weeks' gestation or until onset of labour D. Membrane sweep @ 40 and 41 weeks' gestation or until onset of labour
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
132 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04307199
Sponsor's protocol ID
NUIreland - MILO
Acronym
MILO
Status last verified
May 2020
First submitted
17 Jan 2020
Last updated
14 May 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Finucane EM, Biesty L, Murphy D, Cotter A, Molloy E, O'Donnell M, Treweek S, Gillespie P, Campbell M, Morrison JJ, Alvarez-Iglesias A, Gyte G, Devane D. Feasibility study protocol of a pragmatic, randomised controlled pilot trial: membrane sweeping to prevent post-term pregnancy-the MILO Study. Trials. 2021 Feb 2;22(1):113. doi: 10.1186/s13063-021-05043-9.

    PubMed 33531062

Questions about this trial

What is this clinical trial studying?

A study testing Amniotic membrane sweep in people with Pregnancy, Prolonged and Induced; Birth, run by National University of Ireland, Galway, Ireland.

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 7 inclusion and 3 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 14 May 2020. Status can change between updates, so confirm with the study contact before making plans.

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 Elaine M Finucane, BSc (+353 91 495938, Elainemay.finucane@nuigalway.ie), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Recruitment (time frame: Duration of the recruitment process (approximately 8 months )). The study lists 12 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 NCT04307199, which also lists 1 linked publication.

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 14 May 2020.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in