Study Protocol. The CASPAR study protocol. Can cervical stiffness predict successful vaginal delivery after induction of labour? A feasibility, cohort study.

Abstract

Background Induction of labour (IOL) is a common obstetric intervention in the UK, affecting up to 33% of deliveries. IOL aims to achieve a vaginal delivery prior to spontaneous onset of labour to prevent harm from ongoing pregnancy complications and is known to prevent stillbirths and reduce neonatal intensive care unit admissions. However, IOL doesn’t come without risk and overall, 20% of mothers having an induction will still require a caesarean section birth and in primiparous mothers this rate is even higher. There is no reliable predictive bedside tool available in clinical practice to predict which patient’s undergoing the IOL process will result in a vaginal birth; the fundamental aim of the IOL process. The Bishop’s Score (BS) remains in routine clinical practice as the examination tool to assess the cervix prior to IOL, despite it being proven to be ineffective as a predictive tool and largely subjective. This study will assess the use of the Pregnolia System, a new objective antenatal test of cervical stiffness. This study will explore its’ potential for pre-induction cervical assessment and indication of delivery outcome following IOL. Methods CASPAR is a feasibility study of term, primiparous women with singleton pregnancies undergoing IOL. Cervical stiffness will be assessed using the Pregnolia System; a novel, non-invasive, licensed, CE-marked, aspiration-based device proven to provide objective, quantitative cervical stiffness measurements represented as the Cervical Stiffness Index (CSI, in mbar). A measurement is obtained by applying the sterile single-use Pregnolia Probe directly to the anterior lip of the cervix, visualised via placement of a speculum. Following informed consent, CASPAR study participants will undergo the Pregnolia System cervical stiffness assessment prior to their IOL process commencing. Participant questionnaires will evaluate the acceptability of this assessment tool in this population. This study will directly compare this novel antenatal test to the current BS for both patient experience of the different cervical assessment tools and for IOL outcome prediction. Discussion This feasibility study will explore the use of this novel device in clinical practice for pre-induction cervical assessment and delivery outcome prediction. Our findings will provide novel data that could be instrumental in transforming clinical practice surrounding IOL. Determining recruitment rates and acceptability of this new assessment tool in this population will inform design of a further powered study using the Pregnolia System as the point-of-care, bedside cervical assessment tool within an IOL prediction model. Study registration This study is sponsored by The University of Liverpool and registered at ClinicalTrials.gov, identifier NCT05981469, date of registration 7th July 2023.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

Registered at ClinicalTrials.gov, identifier NCT05981469, date of registration 7th July 2023.

Funding Statement

Yes

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Seasonal Research Ethics Committee has given approval for this research (23/LO/0627). All patients have given written informed consent prior to entry to the study and are aware that participation is completely voluntary.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

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