Feasibility and Acceptability of the Combination of Propess and AN24 Monica for Outpatient Labour Induction (PRAM) (PRAM)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01026948
Recruitment Status : Completed
First Posted : December 7, 2009
Results First Posted : January 6, 2012
Last Update Posted : January 6, 2012
University of Liverpool
Information provided by (Responsible Party):
Liverpool Women's NHS Foundation Trust

Brief Summary:

In order to confirm the feasibility of home monitoring with Monica AN 24, a licensed portable device for measuring fetal and maternal electrocardiogram (ECG), and the feasibility of inpatient monitoring with Monica AN 24 in patients with Propess (a vaginal licensed drug delivery system used for induction of labour), we will perform a pilot study that will include 20 women in each arm.

Feasibility of monitoring with Monica AN 24 both in hospital and at home will be confirmed in a pilot study. The success will be defined as at least 10 minutes of continuous satisfactory trace in any given hour in at least 80% of the patient.

A main study will then be conducted to assess the feasibility and acceptability of the Propess and Monica AN24package of care for women undergoing induction of labour.

The research questions are:

  1. Is outpatient induction with continuous monitoring technically feasible?
  2. Does the Propess and Monica AN24 care package of care provide adequate clinical information in line with the UK National Institute of Clinical Evidence (NICE) Guideline for Induction of labour?
  3. Is outpatient induction a concept that appeals to women?
  4. What do women consider to be the advantages and disadvantages of this package of care?
  5. What would women consider to be positive and/or negative outcome in future clinical trials of outpatient induction?
  6. Do fetuses with abnormal electrocardiogram (ECG) patterns have evidence of subclinically impaired cardiac function (feasibility study)?
  7. Do elevated concentrations of white blood cell components in the umbilical cord blood at birth influence fetal electrocardiogram (feasibility study)?

Condition or disease Intervention/treatment
Intrapartum Fetal Monitoring Pregnancy Drug: Dinoprostone Device: Monica AN 24

  Show Detailed Description

Study Type : Observational
Actual Enrollment : 70 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Feasibility and Acceptability of the Combination of Propess and AN24 Monica for Outpatient Labour Induction (PRAM)
Study Start Date : January 2009
Actual Primary Completion Date : December 2010
Actual Study Completion Date : December 2010

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Group/Cohort Intervention/treatment
Propess and Monica AN24 care package
Women who are eligible and consent to recruitment will receive the Propess and Monica AN24 care package for outpatient induction of labour
Drug: Dinoprostone
Propess© vaginal delivery system consists of a non-biodegradable polymeric drug delivery device containing 10 mg Dinoprostone (PGE2) dispersed throughout its hydrogel matrix. The retrieval vaginal insert expands to twice its size and releases a continuous and predictable dose of Dinoprostone at a rate of approximately 0.3 mg/hr over 24 hours (4-5 mg PGE2 over 12 hours) in women with intact membranes whereas release is higher and more variable in women with premature rupture of membranes.
Other Name: Propess
Device: Monica AN 24
AN24 Monica is a portable, battery powered device designed to passively monitor a pregnant mother and unborn baby. The device is attached via a suitable cable assembly which in turn attaches to 5 standard disposable electrodes placed on the abdomen of a pregnant woman and is intended for use in either the home or hospital environment.
Other Name: CE0843

Primary Outcome Measures :
  1. Feasibility Defined as the Number of Eligible Women Who Are Successfully Monitored Remotely With Trans-abdominal Fetal Electrocardiogram (ECG) Monitoring Device (Monica AN24) While Undergoing Labour Induction. [ Time Frame: 6 months ]
    Outpatient induction is when women recieve medication to induce labour at the hospital, but can then go home for monitoring until labour progresses. When 'standard' Doppler Ultrasound FHR technology is used, women may feel restrained as the Doppler-FHR machine (which is bench-top device) is connected to the transducer which is then mounted on the woman's abdomen and attached by an elastic belt, which is known to be uncomfortable for pregnant woman. The AN 24 device is portable and attaches to the patients abdomen allowing remote fetal monitoring whilst the women are at home.

Secondary Outcome Measures :
  1. Number of Participants Who Were Satisfied With Monitoring at Home [ Time Frame: 6 months ]
    Maternal views were assessed by semi-structured diaries,recording women's ratings on a 4 point scale (very satisfied, satisfied, slightly disatisfied, very disatisfied)of how well they were coping and their satisfaction with outpatient experience.Women completed diaries at least once every two hours at home.Mean scores were calculated for women's ratings of coping, comfort satisfaction and location preference. An interpretive approach was utilised for all open responses. Comments made in the free-text spaces of diaries were categorised to contextualise women's ratings of their experience

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Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
In Liverpool Women's Hospital, women who have completed 37 weeks of Pregnancy and require induction of labour (as per inclusion/exclusion criteria above) while attending Antenatal clinic, delivery suite or the Obstetric Assessment Unit are offered management options. Women who have normal cardiotocogram(CTG), normal amniotic fluid volume and cephalic presentation confirmed by ultrasound, and who decide to have induction of labour were recruited.

Inclusion criteria

Women with singleton pregnancy and cephalic presentation booked for induction of labour with unfavourable cervix (Bishop score <6) and normal pre-induction fetal monitoring.

Low risk women in the context of this study include:

  • Uncomplicated pregnancy requiring induction of labour after completed 37 weeks of of pregnancy with normal fetal assessment including:

    1. Social inductions/maternal requests
    2. Induction of labour for symphysis pubic dysfunction
    3. Obstetric Cholestasis
    4. Nonspecific Proteinuria (without any other medical problems)
  • Parity < 4
  • Intact membranes at study entry
  • Living within a reasonable distance from the hospital (i.e., not more than approximately 60 minutes driving time)
  • Caregiver present at all times while at home
  • Easy access to a safe method of transport for return to hospital
  • Easy access to a telephone (either land line or mobile with good service)
  • Agrees to remove the pessary herself following instructions in the patient leaflet
  • Written informed consent

Exclusion criteria

  • Previous caesarean section
  • Abnormal preinduction cardiotocogram (CTG)
  • Multiple pregnancy
  • Fetal malformation or chromosomal abnormality
  • Maternal age less than 18 years
  • Contraindication to Propess induction
  • Breech Presentation
  • Foetal growth restriction
  • Hypertension
  • All Diabetics

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01026948

United Kingdom
Liverpool Women's NHS Foundation Trust
Liverpool, Merseyside, United Kingdom, L8 7SS
Sponsors and Collaborators
Liverpool Women's NHS Foundation Trust
University of Liverpool
Principal Investigator: Zarko Alfirevic, Professor Liverpool Women's NHS Foundation Trust

Responsible Party: Liverpool Women's NHS Foundation Trust Identifier: NCT01026948     History of Changes
Other Study ID Numbers: LWH0764
First Posted: December 7, 2009    Key Record Dates
Results First Posted: January 6, 2012
Last Update Posted: January 6, 2012
Last Verified: November 2011

Keywords provided by Liverpool Women's NHS Foundation Trust:
Induction of labour
Intraprtum fetal monitoring

Additional relevant MeSH terms:
Reproductive Control Agents
Physiological Effects of Drugs