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Alterations of the Uteroplacental and Fetal Pulmonary Circulation Following Amnioinfusion

Primary Purpose

Severe Oligohydramnios

Status
Unknown status
Phase
Phase 1
Locations
Hungary
Study Type
Interventional
Intervention
amnioinfusion procedure
Sponsored by
Szeged University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Severe Oligohydramnios focused on measuring amnioinfusion, severe idiopahic oligohydramnios

Eligibility Criteria

18 Years - 49 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients above 18 years, who are able to consent;
  2. Singleton pregnancy;
  3. Normal structural examination between 16 and 20 weeks of gestation;
  4. Gestation between 18 and 34 weeks (the pregnancy duration determined by ultrasound verification within the 20th week);
  5. At least two US examinations at the presentation for confirmation and for the diagnosis of persistent oligohydramnios;
  6. Follow up ultrasound examinations weekly in both groups.

Exclusion Criteria:

1. pPROM; 2. Fetal structural anomaly detected at prenatal ultrasonography, or fetal chromosomal abnormalities involving autosomes; 3. Symptoms referring incomplete abortion before 24 weeks of gestation; 4. Maternal contraindications to intervention or prolongation of pregnancy, including severe medical conditions in pregnancy that make the intervention riskful; 5. No active premature labor (shortened cervix <15 mm, <3 cm of cervical dilatation; >6/hour uterine contractions) after 24 weeks of gestation; 6. Cervical cerclage in place; 7. Clear signs of maternal or fetal infection (2 or more of the following: maternal tachycardia >100/min, maternal temperature >38°C, maternal white blood count cells (WBC) >15,000/ml, maternal C-reactive protein (CRP) >20 mg/l, uterine tenderness, foul-smelling vaginal discharge, fetal tachycardia >160 bpm); 8. Suspicion of placental abruption (uterine tenderness and bleeding episodes); 9. Previous invasive procedure in the pregnancy; 10. Fetal condition mandating immediate delivery; 11. Severe bleeding at present; 12. Maternal HIV and HBV/HCV infection; 13. Multiple gestation.

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Sites / Locations

  • University of Szeged, Department of Obstetrics and Gynecology

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

amnioinfusion

Arm Description

The investigators propose an open trial comparing baseline Doppler waveforms in the uteroplacental and fetal pulmonary circulation in patients presenting with severe, idiopathic olighydramnios (AFI<5, no apparent ethiopathology), managed either with single or with serial amnioinfusions. The patients will be followed up weekly in the fetomaternal unit, Dept. of ObGyn for measuring AFI repeatedly to assess the need for further infusions. These will be carried out when the AFI falls below 5cm again

Outcomes

Primary Outcome Measures

Doppler waveforms of the uteroplacental and fetal pulmonary circulation following amnioinfusion

Secondary Outcome Measures

Alterations of the Doppler waveforms during the progress of the pregnancy following amnioinfusion

Full Information

First Posted
December 7, 2010
Last Updated
December 10, 2010
Sponsor
Szeged University
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1. Study Identification

Unique Protocol Identification Number
NCT01258725
Brief Title
Alterations of the Uteroplacental and Fetal Pulmonary Circulation Following Amnioinfusion
Official Title
Alterations of the Uteroplacental and Fetal Pulmonary Circulation in Patients With Severe Idiopathic Oligohydramnios Following Amnioinfusion Therapy in a Longitudinal Study
Study Type
Interventional

2. Study Status

Record Verification Date
December 2010
Overall Recruitment Status
Unknown status
Study Start Date
January 2011 (undefined)
Primary Completion Date
September 2011 (Anticipated)
Study Completion Date
December 2012 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Szeged University

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The aim of this study is to compare the uteroplacental and pulmonary circulation of the fetuses with severe (AFI<5cm) idiopathic oligohydramnios (with unknown origin) to those in normal controls. Further purpose of the study is to measure the changes of the uteroplacental and fetal pulmonary circulation in patients presenting with severe idiopathic oligohydramnios, managed either with single amnioinfusion or with serial amnioinfusions.
Detailed Description
Severe oligohydramnios (AFI<5) is an uncommon complication of pregnancy and it is often associated with Preterm Premature Rupture of the Membranes (pPROM) or with the lethal congenital abnormality. However, in very few cases it is idiopathic (with no obvious etiopathology) and in the prevention of fetal complication (e.g. pulmonary hypoplasia) the amnioinfusion is a treatment option for the persisting oligohydramnios. Severe oligohydramnios for >14 days had a predicted mortality rate >90%. Although severe oligohydramnios and pPROM may lead to pulmonary hypoplasia, all of these three factors are independent predictors of pulmonary hypertension. It is obvious that there are some alterations in the fetal pulmonary circulation in cases of severe oligohydramnios. The preliminary study shows that single/serial amnioinfusion has some beneficial effects on the outcome of the pregnancies complicated with severe idiopathic oligohydramnios: to prolong the gestation, to reduce the number of premature labor and to prevent the adverse neonatal outcome. The investigators propose an open trial comparing baseline Doppler waveforms in the uteroplacental and fetal pulmonary circulation in patients presenting with severe, idiopathic olighydramnios (AFI<5, no apparent ethiopathology), managed either with single or with serial amnioinfusions and in matched controls (matched in gestational age, parity and gravidity, AFI>8). The patients will be followed up weekly in the fetomaternal unit, Dept. of ObGyn for measuring AFI repeatedly to assess the need for further infusions. These will be carried out when the AFI falls below 5cm again. Inclusion criteria: Single pregnancy, severe (AFI<4 cm), idiopathic oligohydramnios between the 18 and 34 weeks of gestation. The study is open and will be run by a single ultrasonographer to avoid interobserver bias, and with a set of minimal number of outcome measures recorded. Primary outcome: Doppler waveforms of the uteroplacental and fetal pulmonary circulation. Alterations in Doppler indices of the Ductus venosus, arteria umbilicalis, arteria uterina, left and right arterial pulmonary branches: (1) systolic/diastolic ratio (S/D), (2) peak systolic velocity; (3) time-averaged velocity; (4) maximum forward velocity during atrial contraction; (5) pulsatility index (PI); (6) Pourcelot's resistance index (RI). The pulsed Doppler measurements of the arterial pulmonary branches will be carried out from a transverse cross-section of the fetal chest at the level of the cardiac 4-chamber view after visualization with color Doppler. Depending on fetal position, the right or left lung will be examined. Doppler waveforms (sample volume: 0.1-0.3 cm) will be first obtained from the most proximal branch of the pulmonary artery, then in the middle lung region at equal distance from the outer border of the heart and the inner thoracic wall and subsequently in the distal lung region as close as possible to the fetal inner thoracic wall. Secondary outcomes: Alterations of the Doppler waveforms during the progress of the pregnancy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Severe Oligohydramnios
Keywords
amnioinfusion, severe idiopahic oligohydramnios

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
amnioinfusion
Arm Type
Experimental
Arm Description
The investigators propose an open trial comparing baseline Doppler waveforms in the uteroplacental and fetal pulmonary circulation in patients presenting with severe, idiopathic olighydramnios (AFI<5, no apparent ethiopathology), managed either with single or with serial amnioinfusions. The patients will be followed up weekly in the fetomaternal unit, Dept. of ObGyn for measuring AFI repeatedly to assess the need for further infusions. These will be carried out when the AFI falls below 5cm again
Intervention Type
Procedure
Intervention Name(s)
amnioinfusion procedure
Other Intervention Name(s)
restoring amniotic fluid volume with intraamniotic transfusion of saline infusion
Intervention Description
Single/serial amnioinfusions aimed at restoring amniotic fluid volume until a normal amount (AFI≥8cm).(Every pregnant women presenting with severe (AFI<5) idiopathic (with unknown origin) oligohydramnios is treated with amnioinfusion at our Dept.)
Primary Outcome Measure Information:
Title
Doppler waveforms of the uteroplacental and fetal pulmonary circulation following amnioinfusion
Time Frame
reaching 34 weeks of gestation
Secondary Outcome Measure Information:
Title
Alterations of the Doppler waveforms during the progress of the pregnancy following amnioinfusion
Time Frame
reaching 34 weeks of gestation

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
49 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients above 18 years, who are able to consent; Singleton pregnancy; Normal structural examination between 16 and 20 weeks of gestation; Gestation between 18 and 34 weeks (the pregnancy duration determined by ultrasound verification within the 20th week); At least two US examinations at the presentation for confirmation and for the diagnosis of persistent oligohydramnios; Follow up ultrasound examinations weekly in both groups. Exclusion Criteria: 1. pPROM; 2. Fetal structural anomaly detected at prenatal ultrasonography, or fetal chromosomal abnormalities involving autosomes; 3. Symptoms referring incomplete abortion before 24 weeks of gestation; 4. Maternal contraindications to intervention or prolongation of pregnancy, including severe medical conditions in pregnancy that make the intervention riskful; 5. No active premature labor (shortened cervix <15 mm, <3 cm of cervical dilatation; >6/hour uterine contractions) after 24 weeks of gestation; 6. Cervical cerclage in place; 7. Clear signs of maternal or fetal infection (2 or more of the following: maternal tachycardia >100/min, maternal temperature >38°C, maternal white blood count cells (WBC) >15,000/ml, maternal C-reactive protein (CRP) >20 mg/l, uterine tenderness, foul-smelling vaginal discharge, fetal tachycardia >160 bpm); 8. Suspicion of placental abruption (uterine tenderness and bleeding episodes); 9. Previous invasive procedure in the pregnancy; 10. Fetal condition mandating immediate delivery; 11. Severe bleeding at present; 12. Maternal HIV and HBV/HCV infection; 13. Multiple gestation. -
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
János Sikovanyecz, M.D., Ph.D.
Organizational Affiliation
University of Szeged, Department of Obstetrics and Gynecology
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Zoltan Kozinszky, M.D., Ph.D.
Organizational Affiliation
Department of Obstetrics and Gynecology, University of Szeged
Official's Role
Study Director
Facility Information:
Facility Name
University of Szeged, Department of Obstetrics and Gynecology
City
Szeged
ZIP/Postal Code
H-6725
Country
Hungary
Facility Contact:
First Name & Middle Initial & Last Name & Degree
János Sikovanyecz, M.D., Ph.D.
Phone
+3662545757
Email
sikovanyecz@freemail.hu

12. IPD Sharing Statement

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Alterations of the Uteroplacental and Fetal Pulmonary Circulation Following Amnioinfusion

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