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Fetal MonitoringNIEM-IINCT06135961

Intrapartum Non-invasive Electrophysiological Monitoring

A study testing eCTG monitoring with the NFMS in people with Fetal Monitoring and Non-invasive, run by Maxima Medical Center at 1 site in Netherlands.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Conventional cardiotocography (CTG) has been used extensively for more than 50 years to monitor the fetal condition during labour, but since the rate of operative deliveries keeps rising, its ability to improve neonatal outcomes is unsatisfactory. 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
Fetal Monitoring, Non-invasive, Cardiotocography
What is being tested?
eCTG monitoring with the NFMS
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
3,471 participants
Where
1 siteNetherlands
Study dates
20 Nov 2023to 15 Feb 2026
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

  • Minimal age of 18 years old
  • Pregnant women with a gestational age between 37+0 and 42+0 weeks and days
  • Indication for fetal monitoring during labour
  • Singleton fetus in cephalic position
  • Oral and written informed consent is obtained

Who cannot join

  • Insufficient knowledge of Dutch or English language
  • Women with a multiple pregnancy
  • Fetal and/or maternal cardiac arrhythmias
  • Contraindications to abdominal patch placement (dermatologic diseases of the abdomen precluding preparation of the abdomen with abrasive paper)
  • Women connected to an external or implanted electrical stimulator, such as Transcutaneous Electro Neuro Stimulation (TENS) and pacemaker (because of disturbance of the electrophysiological signal)
  • Women who take a bath for multiple times during delivery and/or who take a bath for > 1 hour during the first stage of labour and/or who take a bath in the second stage of labour. eCTG monitoring is impossible in bath because the Bluetooth signal is disturbed. In bath, monitoring will be performed by conventional CTG monitoring. However, it is possible to take a shower with eCTG monitoring
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  • Treatment plan (with intervention plan) already made before inclusion is completed.
  • Women who were included in the study, but when circumstances before labour call for delivery of the baby by unplanned caesarean section.
  • There is insufficient time for proper counselling
  • Women admitted with a clinical diagnosis of sepsis with hypotension (i.e. septic shock).

Trial locations and contacts

1 site in 1 country.

Netherlands1 site, 1 recruiting
  • Maxima MC

    Veldhoven, North Brabant, 5504 DB

    Phebe Berben, Medical Doctor, PhD Candidate, +3140 - 888 8000, phebe.berben@mmc.nl

    Guid Oei, Professor

    Recruiting

Other trials in Netherlands

About this study

Official title: Implementation of Intrapartum Non-invasive Electrophysiological Monitoring

Conventional cardiotocography (CTG) has been used extensively for more than 50 years to monitor the fetal condition during labour, but since the rate of operative deliveries keeps rising, its ability to improve neonatal outcomes is unsatisfactory. A transabdominal non-invasive and wireless alternative which overcomes the shortcomings of conventional methods is electrophysiological CTG (eCTG) monitoring. In eCTG the fetal heart rate (FHR) is measured by fetal electrocardiography (NI-fECG) and uterine activity (UA) by electrohysterography (EHG). Both NI-fECG and EHG have been proven more accurate and reliable than conventional non-invasive methods and are less affected by maternal body mass index (BMI).

This study aims to evaluate the mode of delivery, maternal and perinatal outcomes, costs and patient and healthcare professionals perspectives on eCTG monitoring versus the conventional CTG during labour at term with a singleton fetus in cephalic position.

Read more

The eCTG provides a more accurate assessment of the fetus and the UA, compared to the conventional CTG. This allows for optimization of the contraction pattern during high-risk deliveries. We hypothesize that this will reduce the number of operative interventions and improves perinatal outcome. There are three reasons why an improvement in the contraction pattern by the eCTG can influence our outcomes:

  1. EHG can detect excessive UA more accurately. Increased UA is a major risk for fetal distress. In this case, stimulation with oxytocin should be reduced or stopped. More adequate interpretation of FHR, reduced tachysystole and reduced hypertonia is expected to result in fewer instrumented vaginal deliveries and a reduction of caesarean sections due to fetal distress.
  2. EHG can demonstrate unorganized UA that needs to be corrected with a higher dose of oxytocin to enhance contraction frequency and efficiency. This can result in a less exhausted uterine muscle, shorter time to delivery, less vacuum deliveries and caesarean sections due to failure of progress. A shorter time to delivery will also result in a reduction of infections and blood loss.
  3. Accurate registration of the relation between the contraction and decelerations of FHR, is expected to result in more reliable assessment of the fetal condition. This can result in fewer unnecessary operative deliveries and less unpredictable poor perinatal outcomes.
Being tested
eCTG monitoring with the NFMS

What participants receive

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

  • eCTG monitoring with the NFMSDevice

    Device: Nemo Fetal Monitoring System (Nemo Healthcare B.V., Veldhoven, the Netherlands)

Study groups in NCT06135961
Study groupRoleWhat they receive
eCTG monitoringActive comparatoreCTG monitoring with the Nemo Fetal Monitoring System (Nemo Healthcare B.V., Veldhoven, the Netherlands). The NFMS consists of a wireless and beltless electrode patch on the maternal abdomen. It monitors fetal heart rate by fetal electrocardiography, maternal heart rate by maternal electrocardiography and the electrical activity of the uterine muscle by electrohysterography. The advantage of the NFMS is that it is a safe method that can be used in all situations that are contraindicated for invasive monitoring. Furthermore, it can be used when the membranes are not ruptured and the patch does not have to be repetitively repositioned during labor. Because the NFMS is wireless, it gives women more freedom of movement during labor.
Receives: Device: eCTG monitoring with the NFMS
Conventional CTG monitoringNo interventionPhilips Avalon FM 30 (Philips Healthcare, Eindhoven, the Netherlands). The fetal heart rate is measured non-invasively by doppler ultrasound or invasively by fetal scalp electrode. The uterine activity and maternal heart rate is measured by tocodynamometry.

What is being measured

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

  1. The number of operative interventions during labor

    cesarean section or instrumental vaginal delivery

    Measured: During delivery

Secondary outcomes (35)
  1. Duration of the first stage of labor in minutes

    Measured: 0-10 cm dilation during labor

  2. Duration of the second stage of labor in minutes

    Measured: Start pushing until childbirth

  3. The timing and reason of operative interventions during labor

    Timing is defined as:

    • The decision delivery interval for the intervention: emergency ('code red' or within <30 minutes of the decision) or ≥ 1 hour
    • As the phase of delivery: first stage or second stage of labor

    Measured: During delivery

  4. The number of participants with analgesia for pain reduction: epidural or/and remifentanil

    Measured: During delivery

  5. Perineal laceration (grade 1, 2, 3a, 3b, 3c, 4)

    Measured: Directly after childbirth

  6. The number of participants with a mediolateral episiotomy and reason for the episiotomy

    Measured: Directly after childbirth

  7. Number (percentage) and result of fetal blood sampling during the primary and secondary stages of labour

    Measured: During delivery

  8. Perinatal mortality

    Perinatal mortality is defined as the number of fetal deaths past 22 completed weeks (154 days) of gestation plus the number of deaths among live-born children up to seven completed days of life

    Measured: During pregnancy up to seven completed days of life

  9. Neonatal mortality

    Neonatal mortality is defined as the number of neonatal deaths after the seventh day but before the 28th day of life

    Measured: After the seventh day but before the 28th day of life

  10. The number of neonates with hypoxic ischemic encephalopathy

    Measured: childbirth - 28th day postpartum

  11. The number of neonates with Neonatal Respiratory Distress Syndrome (RDS)

    Measured: childbirth - 28th day postpartum

  12. The number of neonates with Meconium Aspiration Syndrome (MAS)

    Measured: childbirth - 28th day postpartum

  13. The number of neonates with convulsions

    Measured: childbirth - 28th day postpartum

  14. The number of neonates with Clinical early onset sepsis

    Clinical early onset is defined as clinical sepsis within the first 72 hours after birth with > 3 days of antibiotics

    Measured: childbirth - 28th day postpartum

  15. The number of neonates with Confirmed early onset sepsis

    Confirmed early onset sepsis is defined as positive cultures of blood, cerebrospinal fluid, or urine from the first 72 hours after birth

    Measured: childbirth - 72 hours after childbirth

  16. The number of neonates with admission to Neonatal Intensive Care Unit

    Measured: childbirth - 28th day postpartum

  17. Length of Admission to Neonatal Intensive Care Unit

    In days

    Measured: childbirth - 28th day postpartum

  18. Reason for the admission to Neonatal Intensive Care Unit

    Measured: childbirth - 28th day postpartum

  19. The number of neonates with the need for mechanical ventilation

    The number of neonates with the need for mechanical ventilation within the first 72 hours after birth

    Measured: childbirth - 72 hours after childbirth

  20. The number of neonates with a 5 minute Apgar score <7

    Measured: 5 minutes after childbirth

  21. The number of neonates with a neonatal acidosis at birth

    It is defined as cord artery pH < 7.05 and base deficit > 12 mmol/L directly after birth. The definition is set as pH < 7.10 and base deficit > 12 mmol/L in cases with only an umbilical vein sample (one available blood gas sample or the pH difference between two samples below 0.03)

    Measured: Directly after childbirth

  22. Maternal mortality

    Maternal mortality or 'pregnancy-related death' is defined as death from any cause related to or aggravated by the pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy

    Measured: During pregnancy and childbirth or within 42 days of termination of pregnancy

  23. The number of mothers admitted to the Intensive Care Unit

    Measured: childbirth until six weeks postpartum

  24. The number of mothers with a thromboembolic event

    Measured: childbirth until six weeks postpartum

  25. The number of mothers with an uterine rupture

    Measured: childbirth until six weeks postpartum

  26. The number of mothers with an obstetric haemorrhage

    Obstetric haemorrhage > 1000 millilitres within 24 hours after giving birth

    Measured: childbirth until 24 hours after childbirth

  27. The number of mothers with a postpartum anemia due to postpartum haemorrhage with requires red cell transfusion

    Measured: childbirth until six weeks postpartum

  28. The number of mothers with a suspected or confirmed postpartum infection requiring antibiotics

    i.e. chorioamnionitis, endometritis, wound infection and/or urinary tract infection.

    Measured: childbirth until six weeks postpartum

  29. Patient satisfaction by questionnaires

    Validated Birth-Satisfaction-Scale-Revised questionnaire and a non-validated questionnaire.

    Measured: 2-6 hours after childbirth

  30. Professional satisfaction by questionnaire

    Non-validated questionnaire

    Measured: 1 year after the start of the study

  31. Costs as a business case model until six weeks postpartum

    Measured: Delivery until six weeks postpartum

  32. For eCTG monitoring: amount of signal loss in percentage of total duration during labour

    The amount of signal loss will be calculated based on the CTG. Signal loss is defined as minutes without registration of the fetal heart rate

    Measured: During delivery

  33. For eCTG monitoring: frequency of switch from Nemo Fetal Monitoring System to conventional CTG + reason, timing and success percentage of the switch

    Measured: During delivery

  34. For eCTG monitoring: EHG pattern within the first 1.5 hours postpartum and the possible association with the amount of bloodloss, medication use and time to placental expulsion

    Measured: First 1.5 hours postpartum

  35. For eCTG monitoring: EHG pattern before and after labour analgesia and the possible association of EHG pattern with labour analgesia

    Measured: During delivery

Timeline

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

  1. First posted18 Nov 2023
  2. Study start20 Nov 2023
  3. Primary completion20 Nov 2025 (estimated)
  4. Study completion15 Feb 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
Diagnosis
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Eligible women will be prospectively included in the cohort receiving conventional CTG monitoring. From the eligible women in the prospective cohort a random sample (90.9%) will be offered eCTG monitoring via a computer generated random collection. Participants will receive eCTG monitoring from the start of fetal monitoring during labour until 1.5 hour after delivery. A retrospective cohort of 2100 women who received conventional CTG monitoring between April 2019 and February 2023 will be added to the prospective cohort for statistical analysis.
Masking
None (open label)
Enrolment
3,471 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06135961
Sponsor's protocol ID
NL82822.015.22
Acronym
NIEM-II
Status last verified
Dec 2023
First submitted
2 Nov 2023
Last updated
15 Dec 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication

Publications

  • Berben PBQ, de Klerk ND, van der Ven M, Fransen AF, Niemarkt HJ, van den Heuvel ER, van der Hout-van der Jagt MB, Oei SG, van Laar JOEH. Non-invasive electrophysiological monitoring vs conventional monitoring during labour in a tertiary obstetric care centre in the Netherlands: study protocol of a cohort intervention random sampling study (NIEM-II study). BMJ Open. 2025 Jul 22;15(7):e102901. doi: 10.1136/bmjopen-2025-102901.

    PubMed 40701589

Questions about this trial

What is this clinical trial studying?

A study testing eCTG monitoring with the NFMS in people with Fetal Monitoring and Non-invasive, run by Maxima Medical Center at 1 site in Netherlands.

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 10 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 15 Dec 2023. 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 Netherlands. 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?

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The number of operative interventions during labor (time frame: During delivery). 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 NCT06135961, 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 15 Dec 2023.

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