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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.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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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

loic.sentilhes@chu-bordeaux.fr

France1 site, 1 recruiting
  • CHU Bordeaux

    Bordeaux

    Hanane Bouchghoul, MD, +335 56 79 55 79, hanane.bouchghoul@chu-bordeaux.fr

    Recruiting

Other trials in France

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.

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 groups in NCT05674487
Study groupRoleWhat they receive
Trans-cervical balloonExperimentalInduction of labor by cervical ripening with trans-cervical balloon (Foley catheter).
Receives: Device: Trans-cervical balloon
MisoprostolActive comparatorInduction 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.

  1. cesarean section

    Incidence of cesarean section defined as a cesarean birth regardless of the indication

    Measured: Day 1

Secondary outcomes (32)
  1. duration of labor

    Mean duration of labor (duration between admission to the labor room and delivery)

    Measured: Day 1

  2. duration between cervical ripening and delivery

    Mean duration between cervical ripening and delivery

    Measured: Day 1

  3. oxytocin use

    Incidence of oxytocin use (median of the maximal administered dosage)

    Measured: Day 1

  4. operative delivery

    Incidence of operative delivery (vacuum, forceps, spatula)

    Measured: Day 1

  5. postpartum hemorrhage

    Incidence of postpartum hemorrhage defined by blood loss >500mL (defined according to the CNGOF criteria)

    Measured: Day 3

  6. Mean total blood loss

    Mean total blood loss (mL)

    Measured: Day 3

  7. 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

  8. iron administration

    Incidence of postpartum intravenous iron administration

    Measured: Day 5

  9. transfusion

    Incidence of transfusion of blood products or blood

    Measured: Day 5

  10. 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

  11. 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

  12. Mean duration of hospitalization

    Mean duration of hospitalization

    Measured: Day 5

  13. umbilical artery lactic acid

    Incidence of umbilical artery lactic acid greater than 10mmol/l

    Measured: Day 1

  14. umbilical artery pH

    Incidence of umbilical artery pH of less than 7,05

    Measured: Day 1

  15. neonatal Apgar Score

    Incidence of neonatal 5 minutes Apgar Score of less than 7

    Measured: Day 1

  16. neonatal hypoglycemia

    Incidence of neonatal hypoglycemia (blood glucose < 35 mg/L) requiring intravenous therapy

    Measured: Day 5

  17. neonatal intensive care

    Incidence of admission to neonatal intensive care unit or intermediate care unit

    Measured: Day 5

  18. neonatal length of hospital stay

    Mean neonatal length of hospital stay

    Measured: Day 5 up to Month 2

  19. neonatal death before discharge

    Incidence of neonatal death before discharge

    Measured: Day 1 up to Month 2

  20. 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

  21. cesarean section for non-reassuring fetal status

    Incidence of cesarean section for non-reassuring fetal status

    Measured: Day 1

  22. cesarean section for arrest of labor

    Incidence of cesarean section for arrest of labor

    Measured: Day 1

  23. 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

  24. neonatal hypoxic-ischemic encephalopathy

    Incidence of neonatal hypoxic-ischemic encephalopathy

    Measured: Day 1 up to Month 2

  25. neonatal seizure

    Incidence of neonatal seizure

    Measured: Day 1

  26. neonatal infection

    Incidence of neonatal infection (confirmed sepsis or pneumonia)

    Measured: Day 1 up to Day 28

  27. neonatal meconium aspiration syndrome

    Incidence of neonatal meconium aspiration syndrome,

    Measured: Day 5

  28. birth trauma

    Incidence of birth trauma (bone fracture, neurologic injury, or retinal hemorrhage),

    Measured: Day 5

  29. neonatal intracranial or subgaleal hemorrhage

    Incidence of neonatal intracranial or subgaleal hemorrhage,

    Measured: Day 5

  30. neonatal arterial hypotensio

    Incidence of neonatal arterial hypotension requiring pressor support

    Measured: day 1

  31. 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.

  32. 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.

  1. First posted6 Jan 2023
  2. Study start9 Apr 2024
  3. Primary completion1 Dec 2026 (estimated)
  4. Study completion1 Dec 2026 (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
Parallel groups
Masking
None (open label)
Enrolment
774 participants (estimated)
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

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.

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