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Reduced fetal movement intervention Trial-2 (ReMIT-2): protocol for a pilot randomised controlled trial of standard care informed by the result of a placental growth factor (PlGF) blood test versus standard care alone in women presenting with reduced feta

Armstrong-Buisseret, Lindsay; Mitchell, Eleanor; Hepburn, Trish; Duley, Lelia; Thornton, Jim G.; Roberts, Tracy E.; Storey, Claire; Smyth, Rebecca; Heazell, Alexander E. P.

Authors

ELEANOR MITCHELL eleanor.mitchell@nottingham.ac.uk
Assistant Professor of Clinical Trials

Lelia Duley

Jim G. Thornton

Tracy E. Roberts

Claire Storey

Rebecca Smyth

Alexander E. P. Heazell



Abstract

Background:
Forty percent of babies who are stillborn born die after 36 weeks gestation and have no lethal structural abnormality. Maternal perception of reduced fetal movement (RFM) is associated with stillbirth and is related to abnormal placental structure and function. The ultimate objective of this trial is to assess whether for women with RFM, intervention directed by measurement of placental biochemical factors in addition to standard care improves pregnancy outcome compared with standard care alone. This is the protocol for a pilot trial to determine the feasibility of a definitive trial and also provide proof of concept that informing care by measurement of placental factors improves neonatal outcomes.

Methods:
ReMIT-2 is a multicentre, pilot randomised controlled trial of care informed by results of an additional placental factor blood test versus standard care alone for women presenting with RFM at or after 36+ 0 weeks gestation. Participants will be randomised 1:1 to the intervention arm where the blood test result is revealed and acted on, or to the control arm where the blood sample is not tested immediately and therefore the result cannot be acted on. All participants will be followed up six weeks after delivery to assess their health status and views of the trial, along with healthcare costs. A sub-group will be interviewed within 16 weeks after delivery to further explore their views of the trial. Outcomes to determine feasibility of a definitive trial include number of potentially eligible women, proportion lost to follow-up, clinical characteristics at randomisation, reasons for non-recruitment, compliance with the trial intervention and views of participants and clinicians about the trial. Proof of concept outcomes include: rates of induction of labour; Caesarean birth; and a composite neonatal outcome of stillbirths and deaths before discharge, 5-min Apgar score less than 7, umbilical artery pH les than 7.05 and admission to neonatal unit for more than 48h.

Discussion: Results from this pilot trial will help determine whether a large definitive trial is feasible. Such a study would provide evidence to guide management of women with RFM and reduce stillbirths.
Trial registration: ISRCTN Registry, ISRCTN12067514. Registered on 8 September 2017.

Citation

Armstrong-Buisseret, L., Mitchell, E., Hepburn, T., Duley, L., Thornton, J. G., Roberts, T. E., …Heazell, A. E. P. (2018). Reduced fetal movement intervention Trial-2 (ReMIT-2): protocol for a pilot randomised controlled trial of standard care informed by the result of a placental growth factor (PlGF) blood test versus standard care alone in women presenting with reduced fetal movement at or after 36+ 0 weeks gestation. Trials, 19, 1-13. https://doi.org/10.1186/s13063-018-2859-1

Journal Article Type Article
Acceptance Date Aug 13, 2018
Online Publication Date Oct 1, 2018
Publication Date Oct 1, 2018
Deposit Date Oct 9, 2018
Publicly Available Date Oct 10, 2018
Journal Trials
Electronic ISSN 1745-6215
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Article Number 531
Pages 1-13
DOI https://doi.org/10.1186/s13063-018-2859-1
Keywords Reduced fetal movement; Placental biomarker; sFlt-1/PlGF ratio; Placenta; Maternal serum; Stillbirth; Perinatal mortality; Feasibility
Public URL https://nottingham-repository.worktribe.com/output/1153463
Publisher URL https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-2859-1

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Reduced fetal movement intervention Trial2 (ReMIT-2): protocol for a pilot randomised controlled trial of standard care informed by the result of a placental growth factor (PlGF) blood test versus standard care alone in women presenting with reduced fetal (1.9 Mb)
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Publisher Licence URL
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