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Safety/Efficacy Study Comparing the Misoprostol Vaginal Insert to Cervidil for Cervical Ripening and Induction of Labor

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.
ClinicalTrials.gov Identifier: NCT00308711
Recruitment Status : Completed
First Posted : March 30, 2006
Results First Posted : February 19, 2010
Last Update Posted : June 25, 2012
Sponsor:
Information provided by (Responsible Party):

March 27, 2006
March 30, 2006
July 29, 2009
February 19, 2010
June 25, 2012
April 2006
August 2007   (Final data collection date for primary outcome measure)
  • Minutes From Drug Insertion to Vaginal Delivery [ Time Frame: 2880 minutes ]
    Interval between time/date of insertion of study drug and time/date of neonate birth. This is a time-to-event analysis, there is no set time for the assessment. The endpoint occurs when the baby is born. 48 hours can be used as an approximate interval by which time most of the babies have been delivered.
  • Percentage of Participants With a Cesarean Section Delivery [ Time Frame: 2880 minutes ]
    Percentage of participants with cesarean delivery after study drug was administered. There is no set assessment time or date as the woman's labor may last hours or days.
Time to vaginal delivery.
Complete list of historical versions of study NCT00308711 on ClinicalTrials.gov Archive Site
  • Percentage of Participants With Maternal/Fetal, Maternal (Post-Partum), and Neonatal Adverse Events [ Time Frame: 96 hours ]
    This outcome reports the percentage of adverse events in each treatment arm spontaneously reported or observed during the study. The intrapartum period (mother is still pregnant) is called the "Maternal/Fetal" period; once the baby has been born, adverse events are assessed separately for the mother (Post Partum) and the baby (Neonatal). The number of adverse events was assessed separately for each of the three periods.
  • Percentage of Participants With Pre-Delivery Oxytocin Use [ Time Frame: 2880 minutes ]
    Incidence in each treatment group of need for oxytocin for pre-delivery induction or augmentation of labor.
  • Percentage of Participants With Cervical Ripening Success Based On Modified Bishop Score (mBS) 12 Hours After Administration of Vaginal Insert [ Time Frame: 12 hours ]
    Measured the percentage of participants who achieved success on the mBS. This composite score is based on the mBS and vaginal delivery and it is measured 12 hours after insertion of the study drug. The mBS has a score of 0 when the cervix is not ripe and a score of 12 when completely ripened. The 12 hour score is compared to baseline. Using the mBS, assess at 12 hours whether each subject has met any of the following three criteria: 1) has improved (increased) the mBS by at least 3 points from baseline; 2) has reached a score of at least 6 on the mBS; or 3) has acheived a vaginal delivery.
  • Minutes to Onset of Active Labor [ Time Frame: 2880 minutes ]
    Interval from insertion of study drug to onset of active labor, defined as at least three contractions in a ten-minute period of at least moderate intensity and resulting in cervical change such as dilatation or effacement; OR at least 4 cm cervical dilatation achieved after progressive change in dilatation.
  • Minutes to Rupture of Membranes (ROM) [ Time Frame: 2880 minutes ]
    Interval from study drug insertion to ROM.
  • Duration of Stay in Minutes in Labor and Delivery Suite [ Time Frame: 5760 minuts ]
    Minutes in Labor and Delivery (L & D) suite starting from insertion of the study drug to discharge from L & D to post partum care.
  • Days in Hospital for Mother and Neonate [ Time Frame: 10 days ]
    Duration of stay in hospital for mother and neonate starting with insertion of the study drug and ending with discharge from the hospital.
  • Incidence of adverse events (including cesarean section) and comparison of overall safety
  • Need for oxytocin, duration of oxytocin use, total dose of oxytocin
  • Successful cervical ripening using Modified Bishop's Score at 12 hours
  • Time to onset of active labor
  • Time to rupture of membranes
  • Duration of stay in labor and delivery suite
  • Duration of stay in hospital for mother and neonate
Not Provided
Not Provided
 
Safety/Efficacy Study Comparing the Misoprostol Vaginal Insert to Cervidil for Cervical Ripening and Induction of Labor
A Multi-center, Randomized, Double-blind Phase III Study of the Efficacy and Safety of the Misoprostol Vaginal Insert Compared to Cervidil for Women Requiring Cervical Ripening and Induction of Labor (The MVP Study).
The purpose of this study is to determine whether the misoprostol vaginal insert (50 mcg and 100 mcg) can safely and effectively speed time to vaginal delivery compared to Cervidil (R) in women who need to have cervical ripneing and induction of labor.

Induction of labor is required in approximately 20% of pregnant women. Although contractions can be brought on by oxytocin ("pitocin"), some women need help in softening the cervix, or mouth of the womb (uterus), before oxytocin can be started. Prostaglandins have been shown to ripen, or soften, the cervix; at present, the only prostaglandin approved for marketing by FDA for this purpose is dinoprostone. Dinoprostone can be delivered in several ways; one method is to use a polymer vaginal insert that slowly releases the dinoprostone directly to the cervical tissues. This product is called Cervidil (R) and has been marketed for more than 10 years in the United States. Misoprostol is another form of prostaglandin that is approved for protecting the stomach and intestinal lining for patients taking NSAIDs. Misoprostol has also been used by many obstetricians for cervical ripening and inducing contractions, but, it is not approved by FDA for this purpose.

The same company that makes the Cervidil polymer insert has made an insert that will slowly release misoprostol. This study will determine whether this investigational insert containing misoprostol will decrease time to vaginal delivery compared to Cervidil. Two different doses of misoprostol will be tested (50 micrograms and 100 micrograms); each vaginal insert will gradually release a small, controlled amount of misoprostol over up to 24 hours.

Comparator: The Cervidil (R) vaginal insert containing dinoprostone will be the comparator in this study.

Interventional
Phase 3
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
  • Cervical Ripening
  • Labor, Induced
  • Drug: Misoprostol vaginal insert 100 mcg
    Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.
    Other Name: Misopess(TM)
  • Drug: Misoprostol vaginal insert 50 mcg
    Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.
    Other Name: Misopess(TM)
  • Drug: Dinoprostone vaginal insert (Cervidil)
    Hydrogel polymer intravaginal insert with retrieval system. One insert is to remain in the posterior fornix of the vagina until removed for one of the following conditions: onset of active labor; maternal/fetal complication, e.g. non-reassuring fetal heart rate. Record if the insert falls out prior to meeting one of the first two criteria. In no case is the insert to remain in place longer than 24h.
    Other Names:
    • Propess(R)
    • 10 mg dinoprostone vaginal insert
  • Experimental: MVI 100
    Misoprostol vaginal insert 100 mcg over 24h
    Intervention: Drug: Misoprostol vaginal insert 100 mcg
  • Experimental: MVI 50
    Misoprostol vaginal insert 50 mcg over 24h
    Intervention: Drug: Misoprostol vaginal insert 50 mcg
  • Active Comparator: Cervidil 10 mg vaginal insert
    Cervidil 10 mg over 24h
    Intervention: Drug: Dinoprostone vaginal insert (Cervidil)

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
1308
August 2007
August 2007   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Pregnant women at least 36 weeks gestation requiring cervical ripening and induction of labor

Exclusion Criteria:

  • No uterine scar (no previous delivery by cesarean section)
  • No multiple gestation
  • No condition that disallows use of prostaglandins for induction of labor
  • No more than 3 previous vaginal births beyond 24 weeks gestation
Sexes Eligible for Study: Female
18 Years and older   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
Canada,   United States
 
 
NCT00308711
Miso-Obs-004
Yes
Not Provided
Not Provided
Ferring Pharmaceuticals
Ferring Pharmaceuticals
Not Provided
Study Director: Helen Colquhoun, MD
Ferring Pharmaceuticals
June 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP