An interventional study of Foley Catheter and Oxytocin in Premature Rupture of Membranes, sponsored by Geisinger Clinic. Completed at 5 sites in United States. Open to female participants, including healthy volunteers. Per ClinicalTrials.gov, last updated 2018-09-24.
Sponsored by Geisinger Clinic · Not applicable, Interventional, and Treatment
Multicenter randomized clinical trial comparing oxytocin versus oxytocin and foley catheter for induction in women who present with premature rupture of membranes who are not in labor.
This is a prospective, randomized, multi-center clinical trial to test the hypothesis that in women with term and near term premature rupture of membranes (PROM), an intrauterine Foley catheter plus oxytocin infusion will decrease the mean time from induction to delivery by 2.5 hours as compared to oxytocin alone.
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Exclusion Criteria:
This arm will receive oxytocin at a rate of 2 milliunits/milliliter. If the fetal status is reassuring, this can be increased by 2 milliunits/milliliter every 30 minutes to achieve an adequate contraction pattern as per the institution's definition to a maximum of 30 milliunits/milliliter. This infusion may be continued until delivery.
Drug: Oxytocin
A 30cc/16 French (16F) foley catheter will be inserted by the provider under direct visualization or by palpation, ensuring that the catheter is appropriately and adequately positioned. Oxytocin will be administered concurrently at a rate of 2 milliunits/milliliter (as noted under oxytocin active comparator). If the catheter remains in place after 12 hours, it will be deflated and removed and oxytocin infusion will continue.
Device: Foley Catheter · Drug: Oxytocin
The balloon will be inflated with 30 cc of sterile saline. The catheter will be taped to the patient's leg so that traction is maintained. The catheter will be assessed hourly for expulsion by a health care provider by applying gentle traction on the catheter or a vaginal examination if it is unclear by traction. Once the Foley catheter is expelled or 12 hours reached, the induction will be continued with oxytocin per this protocol.
Also known as: 30cc/16 French
Each arm will receive oxytocin at a rate of 2 milliunits/milliliter. If the fetal status is reassuring, this can be increased by 2 milliunits/milliliter every 30 minutes to achieve an adequate contraction pattern as per the institution's definition to a maximum of 30 milliunits/milliliter. This infusion may be continued until delivery.
Also known as: Pitocin
Time From Induction of Labor Until Delivery
Time from induction (i.e., start time of Foley catheter or oxytocin) to delivery (hours), analyzed for all deliveries
Time frame: Time from induction to delivery (average 14.2 hours)
Number of Participants With Chorioamnionitis
Number of participants with chorioamnionitis excluding all those who were hospitalized with preterm premature rupture of membranes (PPROM) prior to 34 0/7 weeks. Chorioamnionitis was defined as temperature 38°C (or 100.4°F) or greater with at least two of the following: purulent discharge, maternal tachycardia (heart rate 100 beats per minute or greater), fetal tachycardia (heart rate 160 beats per minute or greater), foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15,000 cells/mL3). Without Restriction = Chorioamnionitis was defined as temperature 38°C or greater and one of the following: purulent discharge, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis. With Restriction = Chorioamnionitis was defined as temperature 38°C or greater and two of the following: purulent discharge, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis.
Time frame: Duration of Labor (average 4.8 hours)
Number of Participants With Vaginal Delivery Within 12 Hours From Placement of Foley Catheter or Start Time of Oxytocin
Time frame: Duration of Labor (average 4.8 hours)
Number of Participants With Vaginal Delivery Within 24 Hours From Placement of Foley Catheter or Start Time of Oxytocin
Time frame: Duration of Labor (average 4.8 hours)
Duration of First, Second and Third Stage of Labor (Minutes) for Those Undergoing Vaginal Deliveries
Time frame: Duration of Labor (average 4.8 hours)
Rate of Failed Induction of Labor as the Indication for Cesarean
This will be defined by a combination of provider documentation and cervical dilation of ≤4cm/90% effaced or ≤5cm/any effacement after a minimum of 12 hours of oxytocin in the setting of adequate contraction. One patient was missing information for failed induction.
Time frame: Duration of Labor (average 4.8 hours)
Rate of Endomyometritis
Endomyometritis defined as: Temperature ≥100.4°F + one of the following: fundal tenderness, maternal tachycardia (Heart Rate ≥ 100 BPM), purulent cervical discharge and no other source of fever
Time frame: Duration of hospital stay (average 3.4 days)
Maternal Length of Stay, From Admission to Discharge (Days)
Time frame: Duration of hospital stay (average 3.4 days)
Rate of Five Minute Apgar Score < 5
Apgar is a test for assessing a newborn shortly after birth to determine if extra medical care or emergency care may be needed. Usually administered at 1 and 5 minutes after birth, the test includes assessment of Appearance, Pulse, Grimace, Activity and Respiration. Scores range from 0 - 10.
Time frame: Duration of hospital stay (average 3.4 days)
Arterial Cord Blood Gas (pH), When Obtained
Time frame: Within 1 hour of delivery
Rate of Neonatal Sepsis
Neonatal sepsis \[positive blood or cerebrospinal fluid (CSF) cultures\]
Time frame: Duration of hospital stay (average 3.4 days)
Neonatal Intensive Care Unit (NICU) Admission Rate
Time frame: Duration of hospital stay (average 3.4 days)
Neonatal Length of Stay
Time frame: Duration of hospital stay (average 3.4 days)
Number of Participants With Confirmed Histologic Chorioamnionitis/Funisitis
Chorioamnionitis/funisitis as determined by the pathologist examining the placenta
Time frame: Duration of hospital stay (average 3.4 days)
Time From Induction to Delivery (Hours)
Time from induction to delivery (hours) excluding all those who were hospitalized with PPROM prior to 34 0/7 weeks
Time frame: Time from induction to delivery (average 14.2 hours)
Overall Cesarean Delivery
Time frame: Duration of hospital stay (average 3.4 days)
Rate of Chorioamnionitis
Chorioamnionitis defined as (Temperature greater than or equal to 100.4 degrees fahrenheit or 38 degrees celsius) with at least 2 of the following: uterine tenderness, maternal tachycardia (HR greater than or equal to 100 bpm), fetal tachycardia (HR greater than or equal to 160bpm), foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15000 cells/cubic milliliter)
Time frame: Duration of hospital stay (average 3.4 days)
Maternal Length of Stay From Delivery to Discharge (Hours)
Time frame: Duration of hospital stay (average 3.4 days)
Women presenting to labor \& delivery with ruptured membranes with an unfavorable cervix based on sterile digital exam at greater than or equal to 34 weeks were approached by a study team member for participation.
| Milestone | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Started | 108 | 93 |
| Received assigned intervention | 113 | 88 |
| Completed | 108 | 93 |
| Not completed | 0 | 0 |
Time from induction (i.e., start time of Foley catheter or oxytocin) to delivery (hours), analyzed for all deliveries
| hours | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Time From Induction of Labor Until Delivery | 14.4 ± 7.9 | 13.9 ± 6.9 |
Number of participants with chorioamnionitis excluding all those who were hospitalized with preterm premature rupture of membranes (PPROM) prior to 34 0/7 weeks. Chorioamnionitis was defined as temperature 38°C (or 100.4°F) or greater with at least two of the following: purulent discharge, maternal tachycardia (heart rate 100 beats per minute or greater), fetal tachycardia (heart rate 160 beats per minute or greater), foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15,000 cells/mL3). Without Restriction = Chorioamnionitis was defined as temperature 38°C or greater and one of the following: purulent discharge, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis. With Restriction = Chorioamnionitis was defined as temperature 38°C or greater and two of the following: purulent discharge, maternal tachycardia, fetal tachycardia, foul odor of the amniotic fluid, or maternal leukocytosis.
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Without Restrictions | 2 | 9 |
| With Restrictions | 0 | 7 |
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Number of Participants With Vaginal Delivery Within 12 Hours From Placement of Foley Catheter or Start Time of Oxytocin | 46 | 34 |
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Number of Participants With Vaginal Delivery Within 24 Hours From Placement of Foley Catheter or Start Time of Oxytocin | 80 | 61 |
| Minutes | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| First Stage | 130 (76.5 to 226) | 188 (111 to 294) |
| Second Stage | 39 (15 to 88) | 23 (11 to 72) |
| Third Stage | 5 (3 to 6) | 5 (3 to 7) |
This will be defined by a combination of provider documentation and cervical dilation of ≤4cm/90% effaced or ≤5cm/any effacement after a minimum of 12 hours of oxytocin in the setting of adequate contraction. One patient was missing information for failed induction.
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Rate of Failed Induction of Labor as the Indication for Cesarean | 6 | 8 |
Endomyometritis defined as: Temperature ≥100.4°F + one of the following: fundal tenderness, maternal tachycardia (Heart Rate ≥ 100 BPM), purulent cervical discharge and no other source of fever
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Rate of Endomyometritis | 0 | 0 |
| days | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Maternal Length of Stay, From Admission to Discharge (Days) | 3 (2 to 3) | 3 (2 to 4) |
Apgar is a test for assessing a newborn shortly after birth to determine if extra medical care or emergency care may be needed. Usually administered at 1 and 5 minutes after birth, the test includes assessment of Appearance, Pulse, Grimace, Activity and Respiration. Scores range from 0 - 10.
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Rate of Five Minute Apgar Score < 5 | 1 | 1 |
| pH | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Arterial Cord Blood Gas (pH), When Obtained | 7.25 ± 0.07 | 7.26 ± 0.07 |
Neonatal sepsis \[positive blood or cerebrospinal fluid (CSF) cultures\]
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Rate of Neonatal Sepsis | 0 | 0 |
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Neonatal Intensive Care Unit (NICU) Admission Rate | 20 | 21 |
| hours | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Neonatal Length of Stay | 49.7 ± 16.9 | 52.4 ± 20.0 |
Chorioamnionitis/funisitis as determined by the pathologist examining the placenta
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Number of Participants With Confirmed Histologic Chorioamnionitis/Funisitis | 9 | 10 |
Time from induction to delivery (hours) excluding all those who were hospitalized with PPROM prior to 34 0/7 weeks
| hours | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Time From Induction to Delivery (Hours) | 14.23 ± 8.19 | 14.16 ± 6.97 |
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Overall Cesarean Delivery | 21 | 25 |
Chorioamnionitis defined as (Temperature greater than or equal to 100.4 degrees fahrenheit or 38 degrees celsius) with at least 2 of the following: uterine tenderness, maternal tachycardia (HR greater than or equal to 100 bpm), fetal tachycardia (HR greater than or equal to 160bpm), foul odor of the amniotic fluid, or maternal leukocytosis (greater than 15000 cells/cubic milliliter)
| Participants | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Rate of Chorioamnionitis | 0 | 7 |
| hours | Oxytocin | Foley Catheter and Oxytocin |
|---|---|---|
| Maternal Length of Stay From Delivery to Discharge (Hours) | 48.1 (38.8 to 57.2) | 47.8 (41.2 to 58.7) |
Collected over Adverse events were monitored from the time of randomization to the time the baby is discharged.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Oxytocin | 0/108 (0%) | 0/108 (0%) | 0/108 (0%) |
| Foley Catheter and Oxytocin | 0/93 (0%) | 0/93 (0%) | 0/93 (0%) |
| Age, Continuous(years) | Oxytocin | Foley Catheter and Oxytocin | Total |
|---|---|---|---|
| Median | 27 (22.8 to 31.4) | 27.5 (23.4 to 32.2) | 27.25 (23.35 to 31.9) |
| Sex: Female, Male(Participants) | Oxytocin | Foley Catheter and Oxytocin | Total |
|---|---|---|---|
| Female | 108 | 93 | 201 |
| Male | 0 | 0 | 0 |
Plan to share: No
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