Fetal Growth RestrictionPROBINNCT05674487
Prostaglandins Versus Trans-cervical Balloon for Induction of Labor in Fetal Growth Restriction (PROBIN)
A study testing Trans-cervical balloon and Misoprostol in people with Fetal Growth Restriction, run by University Hospital, Bordeaux at 1 site in France.
Trial summary
The goal of this randomized trial is to compare two methods of induction in a fetal growth restriction population. The main question it aims to answer is: Is trans-cervical balloon superior to prostaglandins in reducing the cesarean section rate, without increasing neonatal morbidity? Participants will have an… Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Fetal Growth Restriction
- What is being tested?
- Trans-cervical balloon and Misoprostol
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 774 participants
- Where
- 1 siteFrance
- Study dates
- 9 Apr 2024to 1 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age over 18 years
- Singleton gestation, with cephalic presentation
- Gestational age at randomization between entre 34 weeks of gestation and 0 day and 41 weeks of gestation and 0 day
- Fetal growth restriction (FGR). FGR is defined at the third trimester by an abdominal circumference below the 10th centile and/or an estimated fetal weight below the 10th centile (according to local curve), according to the trial DIGITAT. Fetus with normal and abnormal Doppler index can be included.
- Plan for induction of labor whatever the indication (fetal growth restriction or other), the induction of labor is the induction of birth by vaginal delivery
- Bishop Score below 6
- Affiliated or beneficiary to a health security system
- Signed informed consent
Who cannot join
- Contraindication to an induction of labor
- History of previous cesarean delivery, myomectomy by laparotomy or laparoscopy
- Contraindication to misoprostol or trans-cervical balloon
- Known HIV positivity (because of modified delivery plan)
- Known major fetal anomaly or chromosomic anomaly
- Fetal demise
- Patient under legal protection
- Poor understanding of the French language
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Loic Sentilhes, MD, PhD contact
France1 site, 1 recruiting
- Recruiting
CHU Bordeaux
Bordeaux
Hanane Bouchghoul, MD, +335 56 79 55 79, hanane.bouchghoul@chu-bordeaux.fr
About this study
Official title: Prostaglandins Versus Trans-Cervical Balloon for Induction of Labor in Fetal Growth Restriction: a Multicenter Open-label Randomized Trial
The goal of this randomized trial is to compare two methods of induction in a fetal growth restriction population. The main question it aims to answer is:
- Is trans-cervical balloon superior to prostaglandins in reducing the cesarean section rate, without increasing neonatal morbidity? Participants will have an induction of labour by cervical ripening with trans-cervical balloon in the trans-cervical balloon catheter arm and with Prostaglandins in the Misoprostol arm.
Researchers will compare two methods of induction: trans-cervical balloon and prostaglandins to see if trans-cervical balloon is associated with a lower risk of cesarean delivery.
Read the detailed description
Fetal growth restriction (FGR) is associated with increased perinatal morbidity and mortality in late pregnancy. Because of this higher risk of adverse perinatal outcome, induction of labor is often proposed and require cervical ripening when the cervix is not favorable, i.e. Bishop score less than 6. Two methods of cervical ripening are currently available and used: pharmacological (prostaglandins) and mechanical (trans-cervical balloon).
Growth-restricted fetuses are a population at increased risk for non-reassuring fetal status and hypoxia during labor because of their lower weight. Prostaglandins can lead to cardiotocograph (CTG) tracing abnormalities by causing uterine tachysystole in normal-weight fetuses. Nevertheless, the question of the method of induction of labor has been poorly studied in the population of growth-restricted fetuses. None of the national and international societies reports in their guidelines which method of induction of labor should be offered to pregnancies complicated by a fetal growth restriction. A few retrospective studies are in favor of an increased risk of uterine tachysystole with consequences on the CTG tracing in the case of cervical ripening with prostaglandins compared to the trans-cervical balloon. However, the results of these studies lack robustness due to important methodological limitations.
Because trans-cervical balloon is a mechanical method of cervical ripening, it may be less likely to cause uterine tachysystole and thus fewer non-reassuring fetal status. Thus, the risk of cesarean section in labor could be decreased compared with the use of prostaglandins in the growth-restricted fetal population.
To date, there is no published quality randomized controlled trials on the optimal method of cervical ripening in induction of labor for FGR fetuses.
The present large-scale randomized trial aim to define the preferred method of induction for these fetuses, associated with a lower risk of cesarean delivery. If it is demonstrated that one method of induction (trans-cervical balloon) is superior to another (prostaglandins) in reducing the cesarean section rate, without increasing neonatal morbidity, the results of our study are likely to lead to changes in national and international recommendations.
- Conditions
- Fetal Growth Restriction
- Being tested
- Trans-cervical balloon, Misoprostol
- Keywords
- Fetal growth restriction, Cesarean section, Induction of labor, Cervical ripening, Neonatal morbidity
- Medical subject headings
- Fetal Growth Retardation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Trans-cervical balloonDevice
Induction of labor by cervical ripening with trans-cervical balloon (Foley catheter).
MisoprostolDrug
Induction of labor by cervical ripening with Prostaglandins (Misoprostol per os)
| Study group | Role | What they receive |
|---|---|---|
| Trans-cervical balloon | Experimental | Induction of labor by cervical ripening with trans-cervical balloon (Foley catheter). Receives: Device: Trans-cervical balloon |
| Misoprostol | Active comparator | Induction of labor by cervical ripening with Prostaglandins (Misoprostol per os) Receives: Drug: Misoprostol |
What is being measured
The primary outcome is the main question the study is designed to answer.
cesarean section
Incidence of cesarean section defined as a cesarean birth regardless of the indication
Measured: Day 1
Secondary outcomes (32)
duration of labor
Mean duration of labor (duration between admission to the labor room and delivery)
Measured: Day 1
duration between cervical ripening and delivery
Mean duration between cervical ripening and delivery
Measured: Day 1
oxytocin use
Incidence of oxytocin use (median of the maximal administered dosage)
Measured: Day 1
operative delivery
Incidence of operative delivery (vacuum, forceps, spatula)
Measured: Day 1
postpartum hemorrhage
Incidence of postpartum hemorrhage defined by blood loss >500mL (defined according to the CNGOF criteria)
Measured: Day 3
Mean total blood loss
Mean total blood loss (mL)
Measured: Day 3
intra-uterine infectious
Incidence of intra-uterine infectious defined by a fever (maternal temperature equal to or greater than 38°C twice), associated to at least one of the two criterion: persistent fetal tachycardia > 160 bpm, or purulent amniotic fluid (defined according to the CNGOF criteria).
Measured: Day 5
iron administration
Incidence of postpartum intravenous iron administration
Measured: Day 5
transfusion
Incidence of transfusion of blood products or blood
Measured: Day 5
maternal thromboembolism event
Incidence of maternal thromboembolism event (deep venous thrombosis diagnosed using leg Doppler ultrasound or pulmonary embolism diagnosed using computed tomographic pulmonary angiography)
Measured: Day 5
maternal satisfaction
Incidence of maternal satisfaction with a satisfaction questionnaire derived from the childbirth experience questionnaire and satisfaction questionnaire of TRAAP2 study
Measured: Day 5
Mean duration of hospitalization
Mean duration of hospitalization
Measured: Day 5
umbilical artery lactic acid
Incidence of umbilical artery lactic acid greater than 10mmol/l
Measured: Day 1
umbilical artery pH
Incidence of umbilical artery pH of less than 7,05
Measured: Day 1
neonatal Apgar Score
Incidence of neonatal 5 minutes Apgar Score of less than 7
Measured: Day 1
neonatal hypoglycemia
Incidence of neonatal hypoglycemia (blood glucose < 35 mg/L) requiring intravenous therapy
Measured: Day 5
neonatal intensive care
Incidence of admission to neonatal intensive care unit or intermediate care unit
Measured: Day 5
neonatal length of hospital stay
Mean neonatal length of hospital stay
Measured: Day 5 up to Month 2
neonatal death before discharge
Incidence of neonatal death before discharge
Measured: Day 1 up to Month 2
non-reassuring fetal status
Incidence of non-reassuring fetal status occurring after the beginning of the cervical ripening (including both cervical ripening and labor). Non-reassuring fetal status is defined by the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO), who class the CTG tracing in 3 class: normal, suspicious and pathological 3. According to this classification, non-reassuring fetal status is defined as the presence of a suspicious or pathological CTG tracings, predictive of hypoxia/ neonatal acidosis status
Measured: Day 1
cesarean section for non-reassuring fetal status
Incidence of cesarean section for non-reassuring fetal status
Measured: Day 1
cesarean section for arrest of labor
Incidence of cesarean section for arrest of labor
Measured: Day 1
neonatal ventilation
Incidence of the need for neonatal ventilation in the first 72 hours of life, defined by intubation, continuous positive airway pressure (CPAP) or high-flow nasal cannula
Measured: Day 3
neonatal hypoxic-ischemic encephalopathy
Incidence of neonatal hypoxic-ischemic encephalopathy
Measured: Day 1 up to Month 2
neonatal seizure
Incidence of neonatal seizure
Measured: Day 1
neonatal infection
Incidence of neonatal infection (confirmed sepsis or pneumonia)
Measured: Day 1 up to Day 28
neonatal meconium aspiration syndrome
Incidence of neonatal meconium aspiration syndrome,
Measured: Day 5
birth trauma
Incidence of birth trauma (bone fracture, neurologic injury, or retinal hemorrhage),
Measured: Day 5
neonatal intracranial or subgaleal hemorrhage
Incidence of neonatal intracranial or subgaleal hemorrhage,
Measured: Day 5
neonatal arterial hypotensio
Incidence of neonatal arterial hypotension requiring pressor support
Measured: day 1
Maternal Postpartum Depression
Defined by a score greater than 13 on the EPDS (Edinburgh Postpartum Depression Scale). The EPDS scale calculates a depressive symptom score ranging from 0 (no depression symptoms) to 30 (severe depression symptoms). Threshold values greater than 13 are used to identify women at high risk for postpartum depression.
Measured: 2 months after delivery.
Posttraumatic Stress Disorder (PTSD)
Defined by a score greater than 33 on the IES-R (Impact of Event Scale - Revised) questionnaire or by the presence of all criteria from the DSM-IV (4th edition of the Diagnostic and Statistical Manual of Mental Disorders) (criteria A, B, C, D, E, and F) on the TES (Traumatic Event Scale). The IES-R measures the severity of PTSD symptoms over the past 7 days, with scores ranging from 0 (no PTSD symptoms) to 88 (extreme PTSD symptoms). The diagnosis of PTSD is made when the IES-R score is greater than 33.
- Timeframe:
Measured: 2 months after delivery.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Jan 2023
- Study start9 Apr 2024
- Primary completion1 Dec 2026 (estimated)
- Study completion1 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Fetal Growth RestrictionStudies of the same condition, open and under way.
- More trials run by University Hospital, BordeauxThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 774 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University Hospital, Bordeaux
- Sponsor type
- University, hospital or other
- Collaborators
- Ministry of Health, France
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05674487
- Sponsor's protocol ID
- CHUBX 2022/42
- Acronym
- PROBIN
- Status last verified
- Mar 2025
- First submitted
- 30 Dec 2022
- Last updated
- 2 Apr 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Bouchghoul H, Madar H, Froeliger A, Lacoste C, Kret M, Benard A, Sentilhes L; PROBIN study group. Prostaglandins versus transcervical balloon for induction of labor for fetal growth restriction: study protocol for a randomized, multicenter, open-label, superiority trial (PROBIN). BMC Pregnancy Childbirth. 2026 Feb 9;26(1):270. doi: 10.1186/s12884-026-08709-x.
PubMed 41664013
Study at a glance
From the registry record, last updated by the sponsor on 2 Apr 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Prostaglandins Versus Trans-Cervical Balloon for Induction of Labor in Fetal Growth Restriction: a Multicenter Open-label Randomized Trial
- ClinicalTrials.gov ID
- NCT05674487
- Acronym / sponsor ID
- PROBIN / CHUBX 2022/42
- Conditions
- Fetal Growth Restriction
- Keywords
- Fetal growth restriction, Cesarean section, Induction of labor, Cervical ripening, Neonatal morbidity
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 774 participants (estimated)
- Lead sponsor
- University Hospital, BordeauxUniversity, hospital or other
- Collaborators
- Ministry of Health, France
- Study start
- 9 Apr 2024 (actual)
- Primary completion
- 1 Dec 2026 (estimated)
- Study completion
- 1 Dec 2026 (estimated)
- First posted
- 6 Jan 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this randomized trial is to compare two methods of induction in a fetal growth restriction population. The main question it aims to answer is:
- Is trans-cervical balloon superior to prostaglandins in reducing the cesarean section rate, without increasing neonatal morbidity? Participants will have an induction of labour by cervical ripening with trans-cervical balloon in the trans-cervical balloon catheter arm and with Prostaglandins in the Misoprostol arm.
Researchers will compare two methods of induction: trans-cervical balloon and prostaglandins to see if trans-cervical balloon is associated with a lower risk of cesarean delivery.
Detailed description
Fetal growth restriction (FGR) is associated with increased perinatal morbidity and mortality in late pregnancy. Because of this higher risk of adverse perinatal outcome, induction of labor is often proposed and require cervical ripening when the cervix is not favorable, i.e. Bishop score less than 6. Two methods of cervical ripening are currently available and used: pharmacological (prostaglandins) and mechanical (trans-cervical balloon).
Growth-restricted fetuses are a population at increased risk for non-reassuring fetal status and hypoxia during labor because of their lower weight. Prostaglandins can lead to cardiotocograph (CTG) tracing abnormalities by causing uterine tachysystole in normal-weight fetuses. Nevertheless, the question of the method of induction of labor has been poorly studied in the population of growth-restricted fetuses. None of the national and international societies reports in their guidelines which method of induction of labor should be offered to pregnancies complicated by a fetal growth restriction. A few retrospective studies are in favor of an increased risk of uterine tachysystole with consequences on the CTG tracing in the case of cervical ripening with prostaglandins compared to the trans-cervical balloon. However, the results of these studies lack robustness due to important methodological limitations.
Because trans-cervical balloon is a mechanical method of cervical ripening, it may be less likely to cause uterine tachysystole and thus fewer non-reassuring fetal status. Thus, the risk of cesarean section in labor could be decreased compared with the use of prostaglandins in the growth-restricted fetal population.
To date, there is no published quality randomized controlled trials on the optimal method of cervical ripening in induction of labor for FGR fetuses.
The present large-scale randomized trial aim to define the preferred method of induction for these fetuses, associated with a lower risk of cesarean delivery. If it is demonstrated that one method of induction (trans-cervical balloon) is superior to another (prostaglandins) in reducing the cesarean section rate, without increasing neonatal morbidity, the results of our study are likely to lead to changes in national and international recommendations.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Trans-cervical balloon | Experimental | Device: Trans-cervical balloonInduction of labor by cervical ripening with trans-cervical balloon (Foley catheter). |
| Misoprostol | Active comparator | Drug: MisoprostolInduction of labor by cervical ripening with Prostaglandins (Misoprostol per os) |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Age over 18 years
- Singleton gestation, with cephalic presentation
- Gestational age at randomization between entre 34 weeks of gestation and 0 day and 41 weeks of gestation and 0 day
- Fetal growth restriction (FGR). FGR is defined at the third trimester by an abdominal circumference below the 10th centile and/or an estimated fetal weight below the 10th centile (according to local curve), according to the trial DIGITAT. Fetus with normal and abnormal Doppler index can be included.
- Plan for induction of labor whatever the indication (fetal growth restriction or other), the induction of labor is the induction of birth by vaginal delivery
Key exclusion criteria (8 listed)
- Contraindication to an induction of labor
- History of previous cesarean delivery, myomectomy by laparotomy or laparoscopy
- Contraindication to misoprostol or trans-cervical balloon
- Known HIV positivity (because of modified delivery plan)
- Known major fetal anomaly or chromosomic anomaly
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Trans-cervical balloonInduction of labor by cervical ripening with trans-cervical balloon (Foley catheter). | Device | Trans-cervical balloon |
| MisoprostolInduction of labor by cervical ripening with Prostaglandins (Misoprostol per os) | Drug | Misoprostol |
Primary outcome
cesarean section
Time frame: Day 1
Incidence of cesarean section defined as a cesarean birth regardless of the indication
32 secondary outcomes
duration of labor
Time frame: Day 1
duration between cervical ripening and delivery
Time frame: Day 1
oxytocin use
Time frame: Day 1
operative delivery
Time frame: Day 1
postpartum hemorrhage
Time frame: Day 3
Mean total blood loss
Time frame: Day 3
intra-uterine infectious
Time frame: Day 5
iron administration
Time frame: Day 5
transfusion
Time frame: Day 5
maternal thromboembolism event
Time frame: Day 5
maternal satisfaction
Time frame: Day 5
Mean duration of hospitalization
Time frame: Day 5
umbilical artery lactic acid
Time frame: Day 1
umbilical artery pH
Time frame: Day 1
neonatal Apgar Score
Time frame: Day 1
neonatal hypoglycemia
Time frame: Day 5
neonatal intensive care
Time frame: Day 5
neonatal length of hospital stay
Time frame: Day 5 up to Month 2
neonatal death before discharge
Time frame: Day 1 up to Month 2
non-reassuring fetal status
Time frame: Day 1
cesarean section for non-reassuring fetal status
Time frame: Day 1
cesarean section for arrest of labor
Time frame: Day 1
neonatal ventilation
Time frame: Day 3
neonatal hypoxic-ischemic encephalopathy
Time frame: Day 1 up to Month 2
neonatal seizure
Time frame: Day 1
neonatal infection
Time frame: Day 1 up to Day 28
neonatal meconium aspiration syndrome
Time frame: Day 5
birth trauma
Time frame: Day 5
neonatal intracranial or subgaleal hemorrhage
Time frame: Day 5
neonatal arterial hypotensio
Time frame: day 1
Maternal Postpartum Depression
Time frame: 2 months after delivery.
Posttraumatic Stress Disorder (PTSD)
Time frame: 2 months after delivery.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Apr 2025.
- Derived from this study: PubMed 41664013Bouchghoul H, Madar H, Froeliger A, Lacoste C, Kret M, Benard A, Sentilhes L; PROBIN study group. Prostaglandins versus transcervical balloon for induction of labor for fetal growth restriction: study protocol for a randomized, multicenter, open-label, superiority trial (PROBIN). BMC Pregnancy Childbirth. 2026 Feb 9;26(1):270. doi: 10.1186/s12884-026-08709-x.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Loic Sentilhes, MD, PhD contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Trans-cervical balloon and Misoprostol in people with Fetal Growth Restriction, run by University Hospital, Bordeaux at 1 site in France.
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 8 inclusion and 8 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: looking for participants now, as of the sponsor's last update on 2 Apr 2025. 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 France. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Hanane Bouchghoul, MD (+335 57 82 16 12, hanane.bouchghoul@chu-bordeaux.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
cesarean section (time frame: Day 1). 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 NCT05674487, 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 2 Apr 2025.