Performance of the Monica Novii Wireless Patch System in Threatened and Actual Pre-Term Labour

Study Overview
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Brief Summary
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To study the equivalence of the Monica Novii™ Patch System in patients admitted for threatened pre-term labor and for pre-term labor & delivery from 32 +0 weeks gestation by determining the equivalence of the Novii™ Patch System in monitoring Fetal Heart Rate (FHR), Maternal Heart Rate (MHR) and Uterine Contractions (UC) to Doppler FHR, tocodynamometer (TOCO) UC and photo plethysmograph MHR FDA approved predicates

Detailed Description
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The study is a single-center prospective paired comparison trial, to determine the equivalence of the Monica Novii Patch System with FDA cleared Doppler FHR, TOCO UC and photo plethysmograph MHR Predicate. Patients admitted for threatened pre-term labor and for pre-term labour & delivery will be monitored with both devices simultaneously for FHR, UC, and MHR. Only the data from predicate devices will be available to the clinical care team. The equivalence of the Novii data will be compared to that of the simultaneously obtained predicate device data. Since TOCO UC and Doppler FHR are prone to artefact or error in a Pre-Term Labor population, the principal investigator or a member of the study team will decide on: One 30 minute period of 'interpretable' Doppler FHR, photo plethysmograph MHR and TOCO UA from each of the admitted threatened pre-term labor subjects, when the subject is experiencing contractions as demonstrated by the TOCO UC trace and these contractions represent the clinical presentation. One 30 minute period of 'interpretable' Doppler FHR, photo plethysmograph MHR and TOCO UA from each of the pre-term labor & delivery subjects ending as close to delivery as practical. As above the TOCO UC contractions should represent the clinical presentation. The selection of the 30 min periods will be based on data from the predicate only (the Novii FHR and UC data will not be available to the study team). The two 30 min periods will be used for the statistical equivalence calculation. All recorded data will be made available for visual review.

Official Title
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Performance of the Monica Novii Wireless Patch System in Threatened and Actual Pre-Term Labour

Conditions
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Premature Labor

Intervention / Treatment
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* Device: abdominal fetal/maternal monitor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: She will require pre-term labor (at least 32 weeks 0 days gestation) monitoring with a singleton longitudinal, breech, transverse lie pregnancy. She had none of the exclusion criteria Exclusion Criteria: The presence of any of the following factors or conditions would exclude the patient from consideration as a subject: Known major fetal malformation or chromosome abnormality. Multiple gestation A condition for which cesarean will likely be carried out shortly. Involvement in another clinical trial currently or previously in this pregnancy that, in the investigator's opinion, would affect the conduct of this study. Medical or obstetric problem that would preclude the use of abdominal electrodes (e.g., skin eruptions, history of sensitivity to adhesives). Parturient is under age 18. Medical or obstetric problem that in investigator's opinion would make the patient incapable of taking part in the study. Inability to understand the consent information due to medical illness or diminished intellectual capacity, or insurmountable language barrier. Potential for coercion, e.g. Prisoners.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre Term and Threatened Pre-Term Labor<br>abdominal fetal/maternal monitoring | Device: abdominal fetal/maternal monitor<br>* A single passive patch placed on the abdomen that incorporates 5 electrodes and a monitoring device<br>* Other names: Novii Wireless Patch System;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FHR Deming Regression | Standard linear regression of y on x is not appropriate in this situation as the predicate device is not considered a gold standard, but as a device providing a measurement which may itself be subject to error, whereas the standard linear regression method assumes x to be measured without error. Deming regression is a method for calculating the regression line y=α+βx when both variables are subject to error, and the ratio of the error variances in x and y is known (and will be assumed to be equal to 1 in this analysis). | 30min | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FHR Percent Agreement | The fetal heart rate output file from the predicate device is processed to generate a time line plot of FHR data in which the epochs with un-interpretable data (e.g. no FHR value in that 2 second window) are removed to create interpretable only FHR data, i.e. the predicate is represented as 100% successful. A corresponding Monica Novii file is then generated that has the same time epochs as the Doppler FHR data set but containing the Novii FHR data or uninterpretable data (i.e. no FHR value). | 30min | 
| FHR Bland Altman | Bland-Altman plots will be provided separately for each subject, together with an overall assessment using all available data from all subjects. For this overall assessment, the hierarchical nature of the dataset will be taken into account in the statistical analysis. An appropriate statistical approach is described by Bland and Altman , although in practice the analysis may also be accomplished by using a mixed model method. | 30min | 
| MHR Percent agreement | As for FHR | 30min | 
| MHR bland altman | As for FHR | 30min | 
| UC percent agreement | The positive percentage agreement (PA) is determined separately for each subject from the interpretable and uninterpretable data as follows: PA (%)=(a/(a+C))×100 Equation 3 Where: a is the number of minutes when both the Monica Novii Pod/Patch and the predicate devices are interpretable at the same time c is the number of minutes when the Predicate is interpretable but the Monica Novii Pod/Patch is uninterpretable. This can be alternatively described as using only those times when the Predicate device gives Interpretable data, and is defined as the percentage of those times for which the Monica Novii Pod/Patch also gives Interpretable data (i.e. it is analogous to sensitivity but based on reliability). | 30min | 
| UC Positive percent agreement | The Positive Percent Agreement PPA of the Novii System against the Predicate will be determined from the individual contraction detection as follows: PPA(%)=(x/(x+z))×100 Equation 4 Where: x is the total number of individual contractions detected by BOTH the Novii Pod/PATCH and the Predicate z is the total number of individual contractions detected by the Predicate only. Again the test for statistical non-inferiority of percent agreement based on individual uterine contractions will be defined as in Equation 2 for a one-sided 95% confidence interval using t=1.70. | 30min | 
| MHR deming regression | As for FHR deming regression | 30min | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Threatened Premature Labor, Abdominal Fetal ECG