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Perinatal OutcomesNIEM-ONCT06151613

Continuous Non-invasive Electrophysiological Monitoring in High Risk Pregnancies

A study testing continuous eCTG monitoring using the NFMS in people with Perinatal Outcomes and Preterm Birth, 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 The sponsor has not verified this record for over two years, so it may be out of date.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

The goal of this single centre cohort intervention study with historical controls, is to investigate the effect of implementing continuous antepartum electrophysiological CTG (eCTG) monitoring at the Obstetric High Care (OHC), on perinatal and maternal outcomes and obstetric care. Read more about this study

Who is it for?
Ages 18 years and older, women only
What is being tested?
continuous eCTG monitoring using the NFMS
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,911 participants
Where
1 siteNetherlands
Study dates
22 Nov 2023to 20 Nov 2025
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
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥18 years old
  • Singleton pregnancy ≥23+0 weeks of gestation
  • Requiring hospitalization to the OHC for maternal or fetal surveillance (i.e. imminent preterm delivery(PPI), PE, HELLP, pregnancy induced hypertension (PIH), FGR, fetal distress, vaginal blood loss, fetal congenital anomalies)
  • Parents wishing for fetal monitoring

Who cannot join

  • Multiple pregnancy
  • Insufficient knowledge of Dutch or English language
  • 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 (e.g. a pacemaker - exclusion due to possible signal interference)
  • Fetal and/or maternal cardiac disease (i.e. arrhythmia, congenital defect)
  • Treatment plan (with intervention planned within 24 hours after admission) already made before inclusion is completed
  • Women admitted with a clinical diagnosis of sepsis with hypotension (i.e. septic shock).

Trial locations and contacts

1 site in 1 country.

ND de Klerk, MD contact

+40 8888384

nadine.de.klerk@mmc.nl

M. van der Ven, MD contact

+31408888384

myrthe.van.der.ven@mmc.nl

Netherlands1 site, 1 recruiting
  • Maxima Medical Centre

    Veldhoven, North Brabant, 5504DB

    ND de Klerk, MD, +31 40 8888384, nadine.de.klerk@mmc.nl

    Recruiting

Other trials in Netherlands

About this study

Official title: Non-invasive Electrophysiological Monitoring in High Risk Pregnancies at the Obstetric High Care: the NIEM-O Study

The goal of this single centre cohort intervention study with historical controls, is to investigate the effect of implementing continuous antepartum electrophysiological CTG (eCTG) monitoring at the Obstetric High Care (OHC), on perinatal and maternal outcomes and obstetric care.

The main aim is to investigate the effect of both monitoring methods on:

Read more
  • primary outcome: perinatal outcomes (a composite of perinatal mortality or major neonatal morbidity) until hospital discharge
  • secondary outcomes: Maternal mortality, neonatal morbidity, satisfaction for both patient and caregiver, duration of pregnancy, switch of monitoring method, duration of admission to the OHC, timing (planned or emergency) and number of obstetric interventions (such as caesarean section), and admission and duration of admission to the NICU (neonatal intensive care unit).

Eligible women will be prospectively included in the cohort receiving standard treatment: CTG monitoring intermittent up to three times a day. From these eligible women, a random sample (464) of the prospective cohort (511) will be offered to receive a new monitoring method: 24/7 eCTG monitoring. In order to strengthen the comparison between the two groups (eCTG and standard treatment), additional data from 1400 women who received standard treatment in 2014-2019 will be collected retrospectively.

Read the detailed description

Pregnant women in need for maternal and/or fetal monitoring are hospitalized at the obstetric high care (OHC) of Máxima Medical Center (MMC). They are monitored for up to three times a day with conventional cardiotocography (CTG). In the meantime they reside at the OHC, but the status of the fetus and uterine activity (UA) is not monitored. Nemo Healthcare developed a wireless abdominal electrode patch for measuring fetal heart rate (FHR) and UA: The Nemo Fetal Monitoring System (NFMS). Previous research on non-invasive electrophysiological CTG (eCTG) has yielded promising results in monitoring FHR and UA both during pregnancy and labor. With the use of eCTG technology, safe continuous 24/7 monitoring is possible, which is not possible with conventional cardiotocography. The investigators hypothesize that by introducing continuous antepartum eCTG monitoring perinatal and maternal outcomes will improve.

The investigators aim to include 1911 pregnant women ≥18 years old with a singleton pregnancy between 23+0 and 32+0 weeks of gestation requiring hospitalization on the OHC for maternal or fetal surveillance (including 1400 historical controls).

Additional objectives: The collected NFMS and demographic data will be used to develop and verify a mathematical model for the prediction of time until (preterm) birth, which may be used in clinical practice to reduce unnecessary OHC admissions and facilitate a better timing of interventions. Furthermore, data collected in this study (NFMS, accelerometric, annotated ultrasound) will be used for the development and verification of a mathematical model for the automated detection of fetal movements in NFMS data. This latter model might provide new opportunities in non-invasive monitoring of fetal health.

Being tested
continuous eCTG monitoring using the NFMS
Keywords
Electrophysiological monitoring, Cardiotocography, Antepartum monitoring, continuous monitoring, Non-invasive fetal monitoring
Medical subject headings
Premature Birth

What participants receive

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

  • continuous eCTG monitoring using the NFMSDevice

    Eligible women will be prospectively included in the cohort receiving standard treatment: CTG monitoring intermittent up to three times a day. From these eligible women, a random sample (464) of the prospective cohort (511) will be offered to receive a new monitoring method: 24/7 eCTG monitoring with NFMS. In order to strengthen the comparison between the two groups (eCTG and standard treatment), additional data from 1400 women who received standard treatment in 2014-2019 will be collected retrospectively.

Study groups in NCT06151613
Study groupRoleWhat they receive
Continuous eCTG monitoringActive comparatorFor the continuous eCTG monitoring, a wireless abdominal electrode patch (measuring fetal heart rate (FHR) and uterine activity (UA)) is used, developed by Nemo Healthcare: The Nemo Fetal Monitoring System (NFMS). The advantage of the NFMS is that is a safe method for continuous (24/7) fetal monitoring. Furthermore, the patch does not have to be repetitively repositioned during registration, it can be used under the shower and it is wireless giving women more freedom to move around freely. Another benefit of eCTG monitoring is that it is especially suited for women with obesity, where conventional CTG monitoring often fails
Receives: Device: continuous eCTG monitoring using the NFMS
Conventional intermittent CTG monitoringNo interventionConventional intermittent CTG monitoring is performed in Maxima Medical Centre by the use of Philips Avalon FM 30 (Philips Healthcare, Eindhoven, The Netherlands). This is a combined external measurement method using two transducers placed on the maternal abdomen: one to measure fetal heart rate (FHR) by the use of Doppler ultrasound (DU) and the other at the fundus of the uterus to measure uterine activity (UA) pattern (TOCO), keeping them in place with elastic banding.

What is being measured

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

  1. Incidence of perinatal mortality and major neonatal morbidity

    A composite outcome consisting of: 1. Incidence of perinatal mortality and/or 2.Incidence of a major neonatal morbidity (defined as either: Intraventricular hemorrhage (IVH) grade three or more, Periventricular leukomalacia (PVL) grade two or more, Moderate or severe bronchopulmonary dysplasia (BPD), Necrotizing enterocolitis (NEC) grade two or more, or Retinopathy of prematurity (ROP) necessitating laser therapy).

    Measured: during admission (immediately after birth until hospital discharge) or until at least 4 weeks after birth

Secondary outcomes (12)
  1. Incidence of maternal mortality

    Incidence of maternal mortality in percentages

    Measured: From moment of inclusion until six weeks after giving birth

  2. Incidence of neonatal morbidity

    Incidence of other neonatal morbidity then described in the primary outcome (i.e. IVH grade 1-2, PVL grade 1, mild BPD, NEC grade 1, ROP not necessitating laser therapy, hypoxic ischemic encephalopathy, neonatal seizures, neonatal sepsis (culture proven), need for intubation on the delivery room, mechanical ventilation within the first 72 hours after birth, antibiotics within the first 72 hours after birth, spontaneous intestinal perforation (SIP) necessitating surgery, surfactant treatment, Apgar score <7 after 5 minutes, severe metabolic acidosis (pH <7.05 and base deficit ≥12mmol/L).

    Measured: From inclusion assessed up to 6 months after inclusion

  3. Assesment using a surveys (D-QUEST) to measure patient satisfaction

    Patient satisfaction of the given monitoring method, measured using a surveys: D-QUEST (comprises twelve items with a 5-point rating system. A high level of satisfaction is correlated with a high D-QUEST score, (Score between 14 and 70). The questionnaire is given ones to the patient during the trial.

    Measured: At discharge, assessed up to 1 month.

  4. Assesment using a survey (EQ5D5L) to measure patient satisfaction

    Patient satisfaction of the given monitoring method, measured using a survey: EQ5D5L (This assessment tool assigns a numerical value to each response level (i.e., 1 for "no problems", 5 for "extreme problems"/"unable to") and the summing of these values across the five items, results in a score. The score is then placed on a scale, which is numbered from 0 to 100. 100 means the best health one can imagine. 0 means the worst health one can imagine). The questionnaire is given ones to the patient during the trial.

    Measured: EQ5D5L questionnaire is given on day 1 of the admission (day 1 after inclusion). and assessed up to 1 month.

  5. Assesment using one survey (Browns survey) to measure caregiver satisfaction

    Caregiver satisfaction is measured using Browns survey: purpose of this survey is to assess obstetricians' and midwives' use of current fetal-monitoring techniques and their views towards continuous monitoring, using multiple choice options (ranging from strongly agree to strongly disagree).

    Measured: Caregivers are invited to fill in the questionnaire at baseline and at 1 year

  6. Duration of pregnancy in days

    Duration of pregnancy measured in days

    Measured: Measured from first day of pregnancy until birth, pregnancy period must be related to pregnancy at time of inclusion in the study. Assessed up to 5,5 months after inclusion.

  7. Switch of monitoring method from eCTG to CTG monitoring

    Percentage of participants in which a switch is made from eCTG to CTG monitoring

    Measured: From inclusion assessed up to 6 months after inclusion

  8. Duration of admission to the Obstetric High Care in days

    Duration of admission to the Obstetric High Care measured in days

    Measured: From inclusion assessed up to 6 months after inclusion

  9. Timing of obstetric interventions (caesarean section)

    Planned or emergency caesarean section

    Measured: From inclusion assessed up to 6 months after inclusion

  10. Number of obstetric interventions (caesarean section)

    Number of obstetric intervention is measured as number of caesarean sections

    Measured: From inclusion assessed up to 6 months after inclusion

  11. Admission (yes/no) to the NICU (neonatal intensive care unit)

    Admission to NICU is qualified as yes or no

    Measured: From inclusion assessed up to 6 months after inclusion

  12. Duration of admission to the NICU (neonatal intensive care unit) in days.

    Duration of admission to the NICU (neonatal intensive care unit) is measured in days.

    Measured: From inclusion assessed up to 6 months after inclusion

Timeline

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

  1. First posted30 Nov 2023
  2. Study start22 Nov 2023
  3. Primary completion20 Nov 2025 (estimated)
  4. Study completion20 Nov 2025 (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
A single center prospective cohort intervention study with historical controls.
Masking
None (open label)
Enrolment
1,911 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06151613
Sponsor's protocol ID
NL82869.015.22
Acronym
NIEM-O
Status last verified
Dec 2023
First submitted
1 Nov 2023
Last updated
7 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

  • de Klerk ND, de Vries IR, Dieleman JP, Fransen AF, Oei SG. Intrapartum cardiotocographic patterns and perinatal outcomes in extremely preterm births: an exploratory retrospective cohort study. BMC Pregnancy Childbirth. 2026 Mar 27;26(1):494. doi: 10.1186/s12884-026-08954-0.

    PubMed 41896782
  • de Klerk ND, Berben PBQ, de Vries IR, Niemarkt H, Vullings R, van den Heuvel ER, van der Ven M, Fransen AF, Oei SG, van Laar JOEH. Continuous non-invasive electrophysiological monitoring in high-risk pregnancies: study protocol of a cohort intervention random sampling study in a tertiary obstetrical care centre in the Netherlands (NIEM-O study). BMJ Open. 2025 Nov 12;15(11):e102732. doi: 10.1136/bmjopen-2025-102732.

    PubMed 41224309

Questions about this trial

What is this clinical trial studying?

A study testing continuous eCTG monitoring using the NFMS in people with Perinatal Outcomes and Preterm Birth, 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 4 inclusion and 7 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 7 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?

Contact ND de Klerk, MD (+40 8888384, nadine.de.klerk@mmc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of perinatal mortality and major neonatal morbidity (time frame: during admission (immediately after birth until hospital discharge) or until at least 4 weeks after birth). 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 NCT06151613, which also lists 2 linked publications.

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 7 Dec 2023.

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