Nordic Randomized Trial on Laparoscopic Versus Vaginal Cerclage (NORACT)

A

Aarhus University Hospital

Status

Enrolling

Conditions

Cervical Insufficiency
Preterm Birth

Treatments

Procedure: Vaginal cerclage
Procedure: Laparoscopic cerclage

Study type

Interventional

Funder types

Other

Identifiers

NCT06122506
NNF21OC0071037 (Other Grant/Funding Number)
06190

Details and patient eligibility

About

Every year 15 million babies are born prematurely, which can lead to death or life-long disabilities. It is often caused by a dysfunction of the uterine cervix, which constitutes the narrow channel between the vagina and womb. During pregnancy, this channel must remain closed until the beginning of term labor. A weak cervix may not withstand the weight of the fetus, the amniotic fluid and the placenta and the cervical canal will open and cause late miscarriage or preterm delivery. To prevent this, a band (cerclage) can be applied around the cervix either vaginally or laparoscopically prior to a new pregnancy. To evaluate which treatment is best for most women, we will randomize (allocate by chance) women at risk for preterm birth, to either vaginal cerclage or laparoscopic cerclage in the Nordic countries and England

Full description

Both vaginal and abdominal cerclages are procedures that have been used to prevent preterm birth for more than 50 years. However, only one previous study (MAVRIC, Shennan et al. 2020) has compared the two methods in a randomised trial. Other than evidence from the MAVRIC trial there is uncertainty whether an abdominal cerclage should be preferred over vaginal cerclage, and which women would benefit from it the most. NORACT is an open, multicenter, superiority, randomized controlled trial with the overall objective to compare laparoscopic versus vaginal cerclage in woman in whom the clinician has equipoise as to whether an elective vaginal or abdominal cerclage will be the best intervention to prevent preterm birth. Participants will be recruited pre-pregnancy or in early pregnancy and randomised to vaginal or laparoscopic cerclage. If randomised to laparoscopic cerclage this will be inserted pre-pregnancy or before 10+0 weeks of gestation. The vaginal cerclage will be inserted during pregnancy, before 16+0 weeks of gestation. A total sample of 188 participants will be included to detect a target difference of 15% in the primary outcome between the two groups. The two primary outcomes are delivery before 32+0 weeks of gestation and baby death. The study extends from sites in Denmark, Sweden, Norway, Finland, Iceland, and the United Kingdom.

Enrollment

188 estimated patients

Sex

Female

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Women in whom the clinician has equipoise as to whether an elective vaginal or abdominal cerclage will be the best intervention to prevent preterm birth.
  • Not yet pregnant or <10 weeks' pregnant.

Exclusion criteria

  • Any circumstance under which the clinician is not willing to randomize is an exclusion criterion.
  • Any condition or circumstance under which laparoscopic or vaginal cerclage surgery is contraindicated (i.e. on-going pregnancy of more than 10+0 gestational weeks).
  • Language difficulties.

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

188 participants in 2 patient groups

Intervention
Experimental group
Description:
Laparoscopic cerclage
Treatment:
Procedure: Laparoscopic cerclage
Control
Experimental group
Description:
Vaginal cerclage
Treatment:
Procedure: Vaginal cerclage

Trial contacts and locations

2

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Central trial contact

Lea K Hansen, MD

Data sourced from clinicaltrials.gov

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