Cook´s Balloon Versus Dinoprostone for Labor Induction of Term Pregnancies With Fetal Growth Restriction

Study Overview
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Brief Summary
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The goal of this clinical trial is to compare how two methods for cervical ripening work in a population of singleton pregnancies with late-onset fetal growth restriction (FGR) at term. The main question it aims to answer is whether Cook´s balloon (a mechanical method) is superior to vaginal dinoprostone (a pharmacological method) in achieving a vaginal delivery, without increasing neonatal morbidity. Participants will be randomized to receive Cook´s balloon (experimental group) or vaginal dinoprostone (control group) for cervical ripening. Researchers will compare both groups to see if Cook´s balloon is associated with a higher rate of vaginal delivery than vaginal dinoprostone and is not related to increased neonatal morbidity.

Detailed Description
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Late-onset fetal growth restriction (FGR) represents the most common subtype of FGR (70-80%). The greatest risk for these fetuses appears once term pregnancy is reached, when stressful situations are added to their status of relative hypoxia, such as the appearance of contractions and funicular compression. Thus, it has been shown that from week 37-38 the risk of intrauterine mortality increases and there is a general consensus not to prolong these pregnancies beyond this period. In this situation, induction of labor is usually preferred over elective caesarean delivery. However, these fetuses have an increased risk of cesarean section for suspected fetal distress. Mechanical methods for cervical ripening are associated with less uterine stimulation with a lower rate of tachysystole than prostaglandins. Therefore, these methods have been proposed as the optimal approach for late-onset FGR, since they could reduce the rate of cesarean sections for suspected fetal distress. However, there is no published randomized controlled trials on the use of different methods of cervical ripening for labor induction in late-onset FGR. Thus, the investigators postulate that, in late-onset FGR, cervical ripening with a mechanical method (Cook´s balloon) achieves a higher percentage of vaginal deliveries than a pharmacological method (vaginal dinoprostone), being safe for both the mother and the newborn. The main aim of this study is to evaluate whether cervical ripening with Cook balloon for labor induction at term gestation of singleton pregnancies with late-onset FGR achieves a higher rate of vaginal delivery compared to the use of vaginal dinoprostone, without increasing neonatal morbidity.

Official Title
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Cook´s Balloon Versus Dinoprostone for Labor Induction of Term Pregnancies With Fetal Growth Restriction (COLIGROW)

Conditions
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Fetal Growth Retardation

Intervention / Treatment
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* Device: Cook´s balloon
* Drug: Vaginal dinoprostone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Singleton pregnancy Age ≥ 18 years Gestational age (GA) dated by first trimester ultrasound ≥ 37+0 weeks Cephalic presentation Stage I fetal growth restriction, defined as the presence of at least one of these two criteria: Estimated fetal weight (EFW) < 3rd percentile EFW < 10th percentile and at least one of the following: 2.1) Umbilical artery pulsatility index > 95th percentile or 2.2) Cerebral-placental index < 5th percentile Bishop score < 7 Intact fetal membranes No previous caesarean section No contraindications for vaginal delivery or labor induction. Exclusion Criteria: Major fetal malformation Fetal genetic abnormality Fetal congenital infection

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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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: multicenter, randomized (1:1), open-label, 2-arm parallel group, controlled trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cook´s balloon<br>Silicone 80 mL double-balloon cervical ripening catheter with an adjustable-length malleable stylet | Device: Cook´s balloon<br>* Cervical ripening for induction of labor with a mechanical method (Cook´s balloon)<br>* Other names: Double balloon catheter;|
| Active Comparator: Vaginal dinoprostone<br>Vaginal delivery system containing 10 mg dinoprostone (Prostaglandin E2) dispersed throughout its matrix and releasing approximately 0.3 mg/hour dinoprostone over a 24-hour period. | Drug: Vaginal dinoprostone<br>* Cervical ripening for induction of labor with a pharmacological method (vaginal dinoprostone)<br>* Other names: Vaginal prostaglandin E2;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of vaginal delivery | To assess whether cervical ripening with a Cook balloon for induction of labor of term pregnancies with FGR increases the rates of vaginal delivery with respect to the use of vaginal dinoprostone, without increasing neonatal morbidity. | 2 days (from admission to delivery) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of cesarean sections due to suspected fetal distress | To assess whether cervical ripening with a Cook balloon for induction of labor of term pregnancies with FGR decreases the rates of cesarean sections due to suspected fetal distress with respect to the use of vaginal dinoprostone | 2 days (from admission to delivery) | 
| Induction-to-delivery interval | Comparison of the time interval between the onset of cervical ripening and delivery between the two arms | 2 days (from admission to delivery) | 
| Neonatal morbidity | To analyze the neonatal morbidity through the MAIN score (Morbidity assessment index for newborns) of neonatal morbidity and the duration of admissions to the Neonatal Intensive Care Unit (NICU). | From delivery to discharge of the newborn (up to 1 month) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fetal Growth Restriction, Cervical Ripening, Cook's Balloon, Dinoprostone, Labor Induction