Clinical Trial: The Trial of Pessary After Laser for TTTS

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Arabin Cervical Pessary for Prevention of Preterm Birth in Cases of Twin-to-twin Transfusion Syndrome Treated by Fetoscopic Laser Coagulation: The PECEP Laser Trial

Brief Summary: Placing a cervical pessary in severe twin-to-twin transfusion syndrome (TTTS) cases treated by fetoscopic laser coagulation (FLC) decreases the spontaneous preterm birth rate.

Detailed Summary:

Monochorionic (MC) twin pregnancies present with a high rate of fetal complications, most of them associated with the placental vascular anastomoses. Fetoscopic laser coagulation (FLC) is a surgical technique that allows minimally invasive access into the uterus and has emerged as a useful tool in the management of the most common and severe of these complications, twin to twin transfusion syndrome (TTTS). Even though, preterm birth remains a common cause of adverse outcome because TTTS is associated with a 29% risk of delivering before 28 weeks.

A short cervical length (CL), defined as a CL ≤ 25 mm, detected by transvaginal ultrasound is an independent risk factor for preterm birth in twin pregnancies but no effective treatment has been described to prevent it.

Although is usually accepted that in twin pregnancies cerclage may increase the risk of preterm birth, Salomon and co-workers, found that in cases of TTTS with a CL below the 5th percentile (15 mm) at the time of surgery, performing an emergency cerclage prolonged the pregnancy and allow for better outcome, But still preterm birth after FLC remains a big challenge, so new methods to prevent it must be investigated.

Previous studies in singletons and twins have shown that the use of cervical pessary significantly reduces the frequency of birth before 32 weeks and prolongs pregnancy. The advantage of using cervical pessary is that it is less invasive than cerclage and can be removed easily. That's the reason why pessaries could be considered an alternative, non invasive option to prevent preterm birth in cases of twin to twin transfusion syndrome (TTTS) treated by laser surgery.

Sponsor: Hospital Universitari Vall d'Hebron Research Institute

Current Primary Outcome: Delivery before 32 weeks [ Time Frame: Within the first 15 days after delivery ]

Original Primary Outcome: Spontaneous delivery before 34 completed weeks [ Time Frame: Within the first 15 days after delivery ]

Current Secondary Outcome:

• Birth weight [ Time Frame: Within the first 15 days after delivery ]
  Median weight (g) of the newborns at birth.
• Fetal or neonatal death [ Time Frame: Within the first 15 days after the death ]
  Rate of intrauterine demise or neonatal death during the first 24 hours.
• Neonatal morbidity [ Time Frame: 30 days after the discharge from the hospital ]
  Rate of major adverse neonatal outcomes before discharge from the hospital.
• Significant maternal adverse events [ Time Frame: Within 15 days after discharge from the hospital ]
  Rate of heavy bleeding (bleeding that requires a medical intervention), cervical tear (cervical rupture due to the pessary placement), and/or uterine rupture (rupture of the uterus due to contractions or surgery).
• Physical or psychological intolerance to pessary [ Time Frame: Within 15 days after discharge from hospital ]
  Discomfort or pain due to the pessary that makes daily life uncomfortable (number of cases).
• Preterm birth before 37 weeks [ Time Frame: Within 15 days after delivery ]
  Rate of delivery before 36+6 weeks
• Rupture of membranes before 32 weeks [ Time Frame: Within 15 days after delivery ]
  Rupture of amniotic membranes before 31+6 weeks
• Hospitalisation for threatened preterm labour before 32 weeks [ Time Frame: Within 15 days after delivery ]
  Requirement of hospitalisation due to preterm contractions that need medical treatment to try to stop them before 31+6 weeks (rate).
• Time to birth [ Time Frame: Within 15 days after delivery ]
• Preterm birth before 34 weeks [ Time Frame: Within 15 days after delivery ]
  rate of delivery before 33+6 weeks
• Preterm birth before 30 weeks [ Time Frame: Within 15 days after delivery ]
  rate of delivery before 29+6 weeks
• Preterm birth before 28 weeks [ Time Frame: Within 15 days after delivery ]
  rate of delivery before 27+6 weeks

Original Secondary Outcome:

• Birth weight [ Time Frame: Within the first 15 days after delivery ]
  Median weight (g) of the newborns at birth.
• Fetal or neonatal death [ Time Frame: Within the first 15 days after the death ]
  Rate of intrauterine demise or neonatal death during the first 24 hours.
• Neonatal morbidity [ Time Frame: 30 days after the discharge from the hospital ]
  Rate of major adverse neonatal outcomes before discharge from the hospital.
• Significant maternal adverse events [ Time Frame: Within 15 days after discharge from the hospital ]
  Rate of heavy bleeding (bleeding that requires a medical intervention), cervical tear (cervical rupture due to the pessary placement), and/or uterine rupture (rupture of the uterus due to contractions or surgery).
• Physical or psychological intolerance to pessary [ Time Frame: Within 15 days after discharge from hospital ]
  Discomfort or pain due to the pessary that makes daily life uncomfortable (number of cases).
• Spontaneous preterm birth before 37 weeks [ Time Frame: Within 15 days after delivery ]
  Rate of delivery before 36+6 weeks due to spontaneous contractions and labour (excluding iatrogenous causes).
• Spontaneous rupture of membranes before 34 weeks [ Time Frame: Within 15 days after delivery ]
  Rate of spontaneous rupture of amniotic membranes before 33+6 weeks (excluding iatrogenous causes).
• Hospitalisation for threatened preterm labour before 34 weeks [ Time Frame: Within 15 days after delivery ]
  Requirement of hospitalisation due to preterm contractions that need medical treatment to try to stop them before 33+6 weeks (rate).

Information By: Hospital Universitari Vall d'Hebron Research Institute

Dates:
Date Received: April 12, 2011
Date Started: December 2012
Date Completion: June 2018
Last Updated: March 30, 2017
Last Verified: March 2017