Pelvic Organ Prolapse, Vaginal Delivery
Conditions
Keywords
Pelvic Floor Health, levator ani muscle injury, Pelvic Muscle Injury, Vaginal Delivery, Complications, Childbirth, prevention
Brief summary
This study is designed to evaluate the safety and effectiveness of the Materna Prep Device in reducing pelvic muscle injuries during vaginal delivery. Subjects are randomized to Materna Prep Device or Standard of Care without use of the Materna Prep Device Intervention with the Materna Prep Device is expected to be a one-time use of approximately 30-90 minutes during the 1st stage of labor. Subject participation in the study is targeted to be 12 months from the time of the use of the device during delivery.
Detailed description
Vaginal delivery is a major risk factor for pelvic floor dysfunction. Clinical aspects of pelvic floor dysfunction include pelvic organ prolapse, sexual dysfunction, and fecal and urinary incontinence. Trauma to the pelvic structures occurs as the fetal head passes through the vaginal canal, especially with acute distension at the time of crowning - the exiting of the fetal head. The Materna Prep Device is a single-use, semi-automated dilator used during the first phase of labor in order to prepare the vaginal canal for vaginal delivery. By slowly pre-stretching the vagina and surrounding pelvic tissues during labor, the device is essentially dictating the strain rate of the tissue during labor. In previous feasibility studies, the elastic recovery of the tissue has been shown to be on the order of several hours, allowing the benefits of pre-stretching the vagina and surrounding pelvic tissues to last throughout labor. The device is intended to be removed prior to the initiation of the second stage of labor, for delivery to occur unobstructed. The target patient population for this study is nulliparous women entering the first phase of labor and scheduled for vaginal delivery with an epidural.
Interventions
DEVICEMaterna Prep Device
Materna Prep Device
OTHERStandard of Care (SOC)
Standard of Care (SOC)
Sponsors
Materna Medical
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Masking description
The physician reading all ultrasound images will be blinded to randomization
Intervention model description
Randomized Control Study
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Criteria for inclusion 1. Subject is scheduled for vaginal birth. 2. Subject is gestating a single fetus. 3. Subject is nulliparous, or had a previous pregnancy terminated within 24 weeks gestation. 4. Subject is able and willing to comply with the protocol required follow-up visits. 5. Subject is able and willing to provide written informed consent prior to enrollment. 6. In the opinion of the Investigator, the subject has sufficient mental capacity to understand the informed consent form (ICF), comply with the protocol requirements, and provide clinically relevant and reliable feedback regarding their experience with the device. 7. Subject receives epidural anesthesia during labor prior to enrollment. 8. Subject is 18 years of age or older at time of consent.
Exclusion criteria
Criteria for exclusion 1. Subject has high likelihood of less than 1 hour of potential device dilation time after she arrives at the hospital. 2. Subject is planning or requires a Caesarean-section prior to randomization. 3. Subject begins labor with less than 36 weeks gestation. 4. Subject has a neurological disorder that could cause pelvic floor dysfunction, such as multiple sclerosis or spinal cord injury. 5. Subject has a collagen-associated disorder that affects tissue elasticity, such as scleroderma or Ehlers-Danlos syndrome. 6. Subject has a localized (genital tract) or systemic infection. 7. Subject has a medical history which could lead to pelvic floor dysfunction, such as prior pelvic fractures, pelvic soft tissue injuries, or vaginal surgery. 8. Subject has any general health condition or systemic disease that may represent, in the opinion of the Investigator, a potential increased risk associated with device use or pregnancy. 9. Subject has placenta previa or vasa previa. 10. Subject has known significant chromosomal or structural fetal anomalies. 11. Subject has a category 2 and/or 3 fetal tracing that is unresolved. 12. Subject is observed to have friable, denuded, or markedly edematous vaginal tissue during the course of labor.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The occurrence of pelvic muscle injury, defined as complete detachment of the levator ani muscle diagnosed via ultrasound imaging | 3-month Follow-up | Use transperineal ultrasound to identify levator ani muscle detachment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The occurrence of pelvic muscle injury, defined as complete or partial detachment of the levator ani muscle diagnosed via ultrasound imaging | 3-Month Follow-up | Use transperineal ultrasound to identify levator ani muscle detachments |
| Length of 2nd Stage Labor | Intra-Procedure | Compare the length of the second stage of labor, defined as the time from the cervix being dilated to 10 cm to the complete delivery of the baby between study groups. |
| Levator Hiatal Area | 3-month and 12-month Follow-up | Compare the levator hiatal area (cm2 - measurement between pelvic muscle and pelvic bone) |
| Perineal Lacerations | Intra-Procedure | Compare the rate of perineal lacerations determined by visual insepction post-delivery between study groups |
| Obstetric anal sphincter injury - OASI | Intra-Procedure | Compare the rate of tearing of the muscles of the anal sphincter between study groups. |
| C-Sections | Intra-Procedure | Compare the rate of C-Section due to arrest of labot in the second stage |
| Infant APGAR scores | Intra-Procedure | Compare infant APGAR scores between study groups. A score of 7-10 after 5 minutes is reassuring, a score of 4-6 after minutes is moderately abnormal and a score of 0-3 is concerning. |
| Qualitative pelvic health feedback | 3-Month and 12-month Follow-up | Compare qualitative pelvic health feedback assessed by PFIQ-7 (utilizing 4-point scale representing "Not at all" to "quite a bit") questionnaires from subjects between study groups. |
| Qualitative pain | 3-Month and12-month Follow-up | Compare qualitative pain assessed by VAS (0-10, with 0 being No pain and 10 being severe pain) from subjects between study groups |
| User Satifaction | Intra-Procedure | Satisfaction assessed by a clinician satisfaction questionnaire after device use. |
| Operative Delivery | Intra-Procedure | Compare the rate of instrument use in vaginal deliveries between study gorups |
| Types of Perineal Lacerations | Intra-Procedure | Compare rate of the TYPES of perineal lacerations between study groups. |
| Reasons for C-Sections | Intra-Procedure | Compare incidence of the REASONS for C-Sections between study groups |
| First Push to Delivery | Intra-Procedure | Compare the mean time form first push to delivery between study groups. |
Countries
United States
Outcome results
None listed