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Delivery, ObstetricDiBalNCT06506721

Comparison Between Two Medical Devices for Labor Induction After Previous C-section

A study testing Double ballon device, Cook and Hygroscopic cervix dilators, Dilapan-S in people with Delivery, Obstetric and Cesarean Section, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

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 objective of the study ist to compare the Dilapan-S and the Cook Ballon device for the mechanical induction of labour in women with a previous C-section. There is currently lack of data regarding this comparison of the two methods for mechanical labour induction in this patient collective. Read more about this study

Who is it for?
Ages 18 to 60 years, women onlyHealthy volunteers can take part
What is being tested?
Double ballon device, Cook and Hygroscopic cervix dilators, Dilapan-S
Could I receive a placebo?
No, everyone receives an active treatment
How many people
137 participants
Where
1 siteSwitzerland
Study dates
29 Dec 2023to 28 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 to 60 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • All women >= 18years old with a previous CS and an indication of labour induction, between 24-42 weeks of pregnancy.
  • Modified Bishop-Score < 6
  • Informed consent

Who cannot join

  • More than 1 CS
  • Premature rupture of membranes
  • Vaginal infection
  • Intrauterine fetal demise
  • Twin pregnancy
  • Contraindication against labour induction or vaginal delivery
Show all 21Show fewer
  • Vaginal bleeding
  • Simultaneous external administration of prostaglandins planned
  • Placenta praevia, vasa praevia or placenta accreta spectrum
  • Transverse fetal orientation
  • Prolapsed umbilical cord
  • Prior hysterotomy, classic uterine incision, myomectomy or any other full thickness uterine incision (except C-section)
  • Pelvic structural anomaly
  • Active genital herpes infection
  • Invasive cervical cancer
  • Abnormal fetal heart rate pattern
  • Breech presentation
  • Maternal heart disease
  • Polyhydramnios
  • Presentic part above the pelvic inlet
  • Severe maternal hypertension

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Anda P Radan, PD Dr. med. contact

+41/0316321010

Anda-Petronela.Radan@insel.ch

Mihaela M Fluri, Dr. med.univ. contact

+41/0316321010

mihaela-madalina.fluri@insel.ch

Switzerland1 site, 1 recruiting
  • University Hospital of Obstetrics and Gynäkologie, Inselspital

    Bern, 3010

    Anda P Radan, PD Dr. med., 0041/ 0316321010, Anda-Petronela.Radan@insel.ch

    Mihaela M Fluri, Dr. med. univ., 0041/ 0316321010, mihaela-madalina.fluri@insel.ch

    Recruiting

Other trials in Switzerland

About this study

Official title: Balloon Catheter vs. Hygroscopic Cervical Dilator for Labour Induction After Previous Caesarean Section: an Open Prospective Randomized Controlled Trial

The objective of the study ist to compare the Dilapan-S and the Cook Ballon device for the mechanical induction of labour in women with a previous C-section. There is currently lack of data regarding this comparison of the two methods for mechanical labour induction in this patient collective. Any method used for labour induction is therefore off-label. The primary outcome is the time between placement of the device and delivery. Ad secondary outcomes are among others the cesarean delivery rate and patient satisfaction with the induction method.

Read the detailed description

The cesarean section (CS) rate is increasing worldwide, with previous CS being an important factor contributing to this trend. The investigators think that VBAC may be safe, provided a careful selection of the patients is performed. The individual birth management is particularly important if labour has to be induced, as in case of approximately 25% of women attempting VBAC. Counselling patients about labour induction can be challenging, as they should be offered not only a safe, but also an effective method. Labor induction can be achieved by using several approaches: administration of drugs, which induce uterine contractions, such as prostaglandins or oxytocin, performing an amniotomy, or using mechanical methods. In Switzerland and implicitly in the investigators' institution, PGE after CS are rarely employed in carefully selected cases. Oxytocin administration after performing amniotomy is considered to be a safe method, but may be less effective with an unfavorable BISHOP score (<6).

An possible alternative in case of unripe cervix is induction of labour by use of mechanical methods: balloon catheters and laminaria stents. The investigators currently use the double balloon catheter device (Cook Inc) for this purpose. This device is inserted transcervically and both ballons are inflated with sterile 0.9% saline solution. The catheter remains in place until spontaneously expelled or until start of active labour. If neither happens, it will be removed after 12 hours, followed by oxytocin administration and amniotomy.

Recently, an alternative method for mechanical induction is gaining increased attention: the use of hygroscopic cervical dilators. The method seems to be equally effective and safe as directly compared to a single device catheter in a low risk population of women without uterine scar. When used in patients with previous cesarean section, the rate of spontaneous labour seems to resemble existent data for induction with balloon catheter, this including the investigators' collective.

One of the advantages of Dilapan-S® could be the lack of vaginal protrusion and the fact that it does not have to be fixated under tension. Women seem to feel more mobile with Dilapan®, the perception of relaxation moments between contractions as well as sleep periods during the induction seem to be improved with Dilapan®.

Being tested
Double ballon device, Cook, Hygroscopic cervix dilators, Dilapan-S
Keywords
Trial of Labour

What participants receive

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

  • Double ballon device, CookDevice

    Cook double balloon will be introduced transcervically. The double balloon will be inflated with sterile 0-9% saline solution (maximum 80 ml in each balloon of the double device), then the catheter will be fixed with a tape at the women's thigh without traction. The catheter will remain in place until spontaneously expelled or start of active labour.

    If neither happens, the device will be removed after 12-24 hours and oxytocin will be administered and amniotomy as soon as feasible. If the cervix remains unfavorable after two cycles of 6 hours of oxytocin infusion, the induction will be classified as unsuccessful and C-section will be performed.

  • Hygroscopic cervix dilators, Dilapan-SDevice

    A maximum number of 5 hygroscopic cervical dilator rods will be inserted transcervically, after humidification with sterile 0.9% saline solution. They will be fixed in this position by inserting a humidified compress into the vagina. They will remain in place until spontaneously expelled or until start of active labour.

    In neither happens, the devices will be removed after 12-24 hours and oxytocin will be administered and amniotomy as soon as feasible. If the cervix remains unfavorable after two cycles of 6 hours of oxytocin infusion, the induction will be classified as unsuccessful and C-section will be performed.

Study groups in NCT06506721
Study groupRoleWhat they receive
Double balloon deviceActive comparatorIn this group of patients, the labour will be induced using the Cook double balloon device
Receives: Device: Double ballon device, Cook
Hygroscopic cervix dilatorsActive comparatorIn this group of patients, the labour will be induced using the hygroscopic cervix dilators Dilapan-S
Receives: Device: Hygroscopic cervix dilators, Dilapan-S

What is being measured

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

  1. Induction-to-delivery interval (IDI) after induction of labour (COOK catheter or Dilapan) in women with previous CS.

    The time between placement of the device and delivery

    Measured: 72 hours

Secondary outcomes (6)
  1. Cesarean delivery rate

    How many women will get at the end a C-section after inducing the labour

    Measured: 72 hours

  2. Neonatal outcomes

    The cord arterial pH (< 7.10)

    Measured: 2 hours

  3. Neonatal outcomes

    5 minutes APGAR-Score (< 7)

    Measured: 2 hours

  4. Neonatal outcomes

    Transfer to the ICU

    Measured: 2 hours

  5. Maternal infection rate

    To asses the maternal infection status the investigators use the temperature (fever >38.0°), Leucocytosis (> 16.000 G/l), CRP (> 50)

    Measured: 96 hours

  6. Patient satisfaction

    All participant will receive a questionnaire after birth regarding the time from induction initiation until active phase of labour, covering questions such as convenience of the induction method (multiplicity of vaginal manipulation, comfort and pain experience)

    Measured: 96 hours

Timeline

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

  1. First posted17 Jul 2024
  2. Study start29 Dec 2023
  3. Primary completion28 Dec 2026 (estimated)
  4. Study completion28 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
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
Open (unblinded) prospective randomized trial
Masking
None (open label)
Enrolment
137 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06506721
Sponsor's protocol ID
1650
Other IDs
10000993, 2019-02112, CIV-21-12-038486, 2019
Acronym
DiBal
Status last verified
Jan 2025
First submitted
24 Jun 2024
Last updated
14 Jan 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 342: induction of labor for vaginal birth after cesarean delivery. Obstet Gynecol. 2006 Aug;108(2):465-8. doi: 10.1097/00006250-200608000-00045.

    PubMed 16880321
  • Menacker F, Declercq E, Macdorman MF. Cesarean delivery: background, trends, and epidemiology. Semin Perinatol. 2006 Oct;30(5):235-41. doi: 10.1053/j.semperi.2006.07.002.

    PubMed 17011392
  • Greene MF. Vaginal birth after cesarean revisited. N Engl J Med. 2004 Dec 16;351(25):2647-9. doi: 10.1056/NEJMe048277. Epub 2004 Dec 14. No abstract available.

    PubMed 15598961
  • American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine; Caughey AB, Cahill AG, Guise JM, Rouse DJ. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014 Mar;210(3):179-93. doi: 10.1016/j.ajog.2014.01.026.

    PubMed 24565430
  • Martel MJ, MacKinnon CJ; Clinical Practice Obstetrics Committee, Society of Obstetricians and Gynaecologists of Canada. Guidelines for vaginal birth after previous Caesarean birth. J Obstet Gynaecol Can. 2005 Feb;27(2):164-88. doi: 10.1016/s1701-2163(16)30188-8. English, French.

    PubMed 15943001
  • Ravasia DJ, Wood SL, Pollard JK. Uterine rupture during induced trial of labor among women with previous cesarean delivery. Am J Obstet Gynecol. 2000 Nov;183(5):1176-9. doi: 10.1067/mob.2000.109037.

    PubMed 11084562
  • Grobman WA, Gilbert S, Landon MB, Spong CY, Leveno KJ, Rouse DJ, Varner MW, Moawad AH, Caritis SN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, O'Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM, Mercer BM. Outcomes of induction of labor after one prior cesarean. Obstet Gynecol. 2007 Feb;109(2 Pt 1):262-9. doi: 10.1097/01.AOG.0000254169.49346.e9.

    PubMed 17267822
  • Saad AF, Villarreal J, Eid J, Spencer N, Ellis V, Hankins GD, Saade GR. A randomized controlled trial of Dilapan-S vs Foley balloon for preinduction cervical ripening (DILAFOL trial). Am J Obstet Gynecol. 2019 Mar;220(3):275.e1-275.e9. doi: 10.1016/j.ajog.2019.01.008. Epub 2019 Feb 18.

    PubMed 30790569
  • Radan AP, Amylidi-Mohr S, Mosimann B, Simillion C, Raio L, Mueller M, Surbek D. Safety and effectiveness of labour induction after caesarean section using balloon catheter or oxytocin. Swiss Med Wkly. 2017 Nov 8;147:w14532. doi: 10.4414/smw.2017.14532. eCollection 2017.

    PubMed 29120029
  • Gupta J, Chodankar R, Baev O, Bahlmann F, Brega E, Gala A, Hellmeyer L, Hruban L, Maier J, Mehta P, Murthy A, Ritter M, Saad A, Shmakov R, Suneja A, Zahumensky J, Gdovinova D. Synthetic osmotic dilators in the induction of labour-An international multicentre observational study. Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:70-75. doi: 10.1016/j.ejogrb.2018.08.004. Epub 2018 Aug 3.

    PubMed 30107363
  • Koenigbauer JT, Schalinski E, Jarchau U, Gauger U, Brandt K, Klaucke S, Scharf JP, Rath W, Hellmeyer L. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2. J Perinat Med. 2021 Aug 2;49(7):797-805. doi: 10.1515/jpm-2021-0157. Print 2021 Sep 27.

    PubMed 34333894
  • Mueller M, Kolly L, Bauman M, Imboden S, Surbek D. Analysis of caesarean section rates over time in a single Swiss centre using a ten-group classification system. Swiss Med Wkly. 2014 Feb 19;144:w13921. doi: 10.4414/smw.2014.13921.

    PubMed 24554332
  • Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: Final Data for 2014. Natl Vital Stat Rep. 2015 Dec;64(12):1-64.

    PubMed 26727629
  • Christmann-Schmid C, Raio L, Scheibner K, Muller M, Surbek D. Back to "once a caesarean: always a caesarean"? A trend analysis in Switzerland. Arch Gynecol Obstet. 2016 Nov;294(5):905-910. doi: 10.1007/s00404-016-4055-4. Epub 2016 Mar 15.

    PubMed 26980229

Questions about this trial

What is this clinical trial studying?

A study testing Double ballon device, Cook and Hygroscopic cervix dilators, Dilapan-S in people with Delivery, Obstetric and Cesarean Section, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

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 3 inclusion and 21 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 14 Jan 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 Switzerland. 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 Anda P Radan, PD Dr. med. (+41/0316321010, Anda-Petronela.Radan@insel.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Induction-to-delivery interval (IDI) after induction of labour (COOK catheter or Dilapan) in women with previous CS. (time frame: 72 hours). 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 NCT06506721, which also lists 14 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 14 Jan 2025.

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