Sildenafil Citrate to Improve Maternal and Neonatal Outcomes in Low-resource Settings (PRISM)

NICHD Global Network for Women's and Children's Health

Status: Completed

Conditions: Perinatal Asphyxia; Stillbirth; Birth Asphyxia; Fetal Distress

Study type: Observational

Funder types: Other; NETWORK

Identifiers

NCT05946681

GN03 PRISM Sildenafil Pilot

Details and patient eligibility

About

The PRISM pilot feasibility study consists of two phases to determine: 1) to delivery practices, rates of primary and secondary outcomes, and feasibility of enrollment rates, and 2) to assess the feasibility and acceptability of the intervention and expected enrollment rates, and estimate the effect size of sildenafil citrate on maternal and neonatal outcomes in a low resource settings in preparation for the main RCT.

Full description

The primary objectives of the PRISM pilot study relate to feasibility of a large randomized controlled trial of intrapartum sildenafil citrate and will aid in design of a definitive trial among pregnant women to day 42 postpartum (pp) and their newborns to day 28 pp. The pilot will help prepare for the main trial by allowing the investigators to:

• Determine the rate and indication for fetal heart rate monitoring practices;
• Determine the rate and indications for operative delivery;
• Inform the rates of relevant primary and secondary outcomes to possibly target in a large randomized controlled trial of intrapartum sildenafil citrate;
• Assess the feasibility and acceptability of the intervention and expected enrollment rates;
• Estimate the effect size of sildenafil citrate on maternal and neonatal outcomes in a low resource setting.

Enrollment: 1,017 patients

Sex: Female

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Admission to facility with plan for spontaneous or induced vaginal delivery
• Early stage of labor (≤ 6 cm cervical dilation per local standard) at ≥ 37 weeks gestation
• Age ≥ 18 years of age
• Presence of single live fetus confirmed via a fetal heart rate by Doptone in cephalic position
• Provision of written informed consent [Note: if written consent is obtained at an early time, verbal re-confirmation is required at time of enrollment]

Exclusion criteria

• Non-emancipated minors (as per local regulations)
• Plan for Cesarean delivery or history of cesarean section prior to enrollment*
• Unknown gestational age
• Advanced stage of labor (>6 cm or 10 cm cervical dilation per local standards) and pushing or too distressed to understand, confirm, or give informed consent regardless of cervical dilation
• Not capable of giving consent due to other health problems such as obstetric emergencies (for example, antepartum hemorrhage) or mental disorder;
• Any medical condition considered a contraindication, including contraindication to sildenafil therapy, per the judgement of site investigators
• Any maternal medical condition or status that precludes informed consent
• Recognized fetal anomaly