Vaginal Progesterone in Twins With Short Cervix

Study Overview
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Brief Summary
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A Multicenter, Double-Blind, Placebo-Controlled Randomized Clinical Trial of Vaginal Progesterone to Prevent Early Preterm Birth In Twin Pregnancy with Short Cervix.

Detailed Description
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This is a placebo-controlled, double-blind, randomized clinical trial of asymptomatic women with twin pregnancy and a cervix length 10 mm to 25 mm discovered on a routine screening transvaginal sonogram between 20w0d to 24w0d gestational age. Women will be randomized in either the in-patient or out-patient setting (1:1) to a daily vaginal application of micronized progesterone cream(200 mg)vs. placebo to determine if daily vaginal progesterone administration reduces the risk of preterm birth prior to 34w0d of gestation.

Official Title
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Vaginal Progesterone to Prevent Early Preterm Birth In Twin Pregnancy With Short Cervix. Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Conditions
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Premature Birth

Intervention / Treatment
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* Drug: Vaginal Progesterone gel.
* Procedure: fetal fibronectin swab.
* Drug: Placebo gel


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Gestational age between 20w0d and 24w0d Twin pregnancy, diamniotic-dichorionic, both twins living Cervical length 10 mm to 25 mm discovered by a screening transvaginal ultrasound exam Exclusion Criteria: Mother less than 18 years of age Uterine contractions of 40 seconds duration or more, 10 or more per hour Rupture of fetal membranes (leakage of amniotic fluid one or both sacs) Ongoing vaginal bleeding Any condition likely to cause serious neonatal morbidity independent of gestational age, including: fetal malformation likely to require surgery fetal malformation involving vital organs fetal viral infection hydrops fetalis discordance in estimated fetal weight more than 10% velamentous insertion of umbilical cord of either twin placenta previa of either placenta Any contraindication to continuing the pregnancy Cervical cerclage in place or planned Any contraindication to vaginal micronized progesterone, including: Known sensitivity to progesterone or any of the other ingredients Liver dysfunction or disease Known or suspected malignancy of breast or genital organs Active thromboembolic disorder, or history of hormone-associated thromboembolic disorder

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Vaginal Progesterone<br>Daily administration of Vaginal Progesterone (200mg) Gel between 20 weeks of pregnancy and 34 weeks of pregnancy. | Drug: Vaginal Progesterone gel.<br>* Daily administration of Vaginal Progesterone gel in pregnant women with twins between the 20th week of pregnancy and the 34th week of pregnancy.<br>* Other names: progestin;Procedure: fetal fibronectin swab.<br>* Collection of quantatative fetal fibronectin swab one week after randomization into the trial for both arms. Randomziation occurs between 20 weeks - 24 weeks of gestation.<br>* Other names: fibronectin;|
| Placebo Comparator: Placebo<br>Daily vaginal administration of Placebo gel (Vanicream)between 20 weeks of pregnancy and 34 weeks of pregnancy. | Procedure: fetal fibronectin swab.<br>* Collection of quantatative fetal fibronectin swab one week after randomization into the trial for both arms. Randomziation occurs between 20 weeks - 24 weeks of gestation.<br>* Other names: fibronectin;Drug: Placebo gel<br>* weekly vaginal administration of the placebo gel from randomization until 34 weeks of gestation.<br>* Other names: placebo;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Birth of baby before 34 weeks of gestation | The primary outcome is defined as Early Preterm Birth, that is, birth before 34weeks of gestation. A birth at 33weeks 6days or earlier is considered to have the primary outcome. A birth at 34weeks 0days or later does not have the primary outcome. Births for any reason before 34weeks 0days are considered to have the primary outcome, whether they are spontaneous or not. | At the time of delivery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gestational age of baby at birth | measured of the average Gestational age of babies at birth. | measure at time of birth | 
| Rate of spontaneous birth before 34weeks of gestation | Rate of spontaneous birth before 34weeks of gestation. Spontaneous births are those whose underlying cause is judged to be due to preterm labor, prelabor rupture of membranes, or cervical insufficiency. (In contradistinction, indicated deliveries are those due to preeclampsia, fetal growth problems, fetal heart rate abnormalities, and other problems.) | from randomization to birth of the baby - up to 15 weeks | 
| Rate of composite neonatal morbidity | Composite morbidity is defined as any one or more of: stillbirth, neonatal death, infant death before hospital discharge, respiratory distress syndrome (RDS), intracranial hemorrhage (grade 3 or 4)(IVH), necrotizing enterocolitis (stage 2 or 3)(NEC), documented neonatal sepsis within 72 hr of birth, or periventricular leukomalacia (characteristic lesions in the subcortical white matter seen on cerebral imaging studies within 96 hrs of birth)(PVL). | measures from randomization to 60 days post delivery of the baby | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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premature birth, twins, short cervix