E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Placental insufficiency |
Insuficiencia placentaria |
|
E.1.1.1 | Medical condition in easily understood language |
Placental Insufficiency |
insuficiencia placentaria |
|
E.1.1.2 | Therapeutic area | Diseases [C] - Female diseases of the urinary and reproductive systems and pregancy complications [C13] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10035138 |
E.1.2 | Term | Placental insufficiency |
E.1.2 | System Organ Class | 10036585 - Pregnancy, puerperium and perinatal conditions |
|
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To establish wether a prophylactic intervention from first trimestre with low-dose of aspirine improves trophoblastic invasion evaluated at third trimester in women defined as high-risk by abnormal uterine artery Doppler at first trimester. |
Demostrar que el tratamiento con ácido acetilsalicilico a bajas dosis en gestantes de riesgo por doppler patológico de las arterias uterinas en el primer trimestre resulta en una reducción de la resistencia de la circulación placentaria en tercer trimestre |
|
E.2.2 | Secondary objectives of the trial |
-To establish wether a prophylactic intervention with low-dose of aspirin results in a lower incidence or preeclampsia in pregnant women defined as high-risk by abnormal uterine artery Doppler at first trimester.
-To establish wether a prophylactic intervention with low-dose of aspirin results in a lower incidence of intrauterine growth retardation in pregnant women defined as high-risk by abnormal uterine artery Doppler at first trimester.
-To establish wether a prophylactic intervention with low-dose of aspirin results in a lower incidence of births below 34 weeks in pregnant women defined as high-risk by abnormal uterine artery Doppler at first trimester. |
-Demostrar que el tratamiento con acido acetilsalicílico a bajas dosis en gestantes de riesgo por doppler patológico de las arterias uterinas en el primer trimestre resulta en una menor incidencia de preclampsia.
-Demostrar que el tratamiento con acido acetilsalicílico a bajas dosis en gestantes de riesgo por doppler patológico de las arterias uterinas en el primer trimestre resulta en una menor incidencia de retraso de crecimiento intrauterino.
-Demostrar que el tratamiento con acido acetilsalicílico a bajas dosis en gestantes de riesgo por doppler patológico de las arterias uterinas en el primer trimestre resulta en una menor incidencia de partos por debajo de las 34 semanas |
|
E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
-Patients over 18 years old attending for routine ultrasound at first trimester of pregnancy between 11 and 14 weeks of gestation (Crown-to rump length: 45-48 mm)
-Single gestation
-Mean pulsatility index of the uterine arteries above the 95th percentile for our population |
-Pacientes mayores de 18 años que acudan para ecografía de rutina de primer trimestre de la gestación entre las 11 y las 14 semanas de gestación (longitud cráneo caudal 45-48 mm)
-Gestaciones únicas
-Índice de pulsatilidad medio de las arterias uterinas por encima del percentil 95 para nuestra población |
|
E.4 | Principal exclusion criteria |
-Pre-existing hypertension, renal or cardiovascular disease - previous history of preeclampsia -Pregestational diabetes
-Systemic Lupus Erythematosus
-Gastric ulcer
-Acetylsalicylic acid or lactose Hypersensitivity
-Bleeding disorders
Fetal malformations (including chromosomal abnormalities)
-Administration of low molecular weight heparin - concomitant treatment with aspirine |
- Enfermedad preexistente hipertensiva, renal o cardiovascular -Antecedentes de preeclampsia
-Diabetes pregestacional
-Lupus eritemasoso sistémico
-Úlcera gástrica
-Hipersensibilidad al ácido acetilsalicílico o la lactosa
-Enfermedades hemorrágicas
-Malformaciones fetales (incluidas cromosomopatías)
-Administración de heparina de bajo peso molecular - tratamiento concomitante con aspirina |
|
E.5 End points |
E.5.1 | Primary end point(s) |
-Uterine artery mean pulsatility index at 28 weeks. |
-Índice de pulsatilidad medio de las arterias uterinas a las 28 semanas |
|
E.5.1.1 | Timepoint(s) of evaluation of this end point |
|
E.5.2 | Secondary end point(s) |
-Uterine artery pulsatility index at 28 weeks.
-Pre-eclampsia: diastolic blood pressure (DBP)> = 90 mmHg) or systolic (SBP)> = 140 mmHg on two separated determinations (> 4h) with proteinuria> 300 mg/24 h
-Gestational age at debut of preeclampsia
-Severe preeclampsia: preeclampsia criteria + DBP> = 110 mmHg, proteinuria> 5g/24h, oligouria (<400 ml/24h), neurological symptoms (brain or visual), acute pulmonary edema (gasometric and radiological criteria), persistent epigastric pain, abnormal liver function (AST or ALT> 70 IU), analytical signs of hemolysis (LDH> 700 U / L) and / or thrombocytopenia (<100.000/ml).
-Gestational age at delivery (preterm birth: before 34 weeks gestation)
-Intrauterine Growth Retardation: birth weight below the 10th percentile of our population + pulsatility index in umbilical artery in the third trimester (on two separate occasions >48h) above the 95th percentile.
-Emergent cesarean section due to fetal wellbeing loss
-Birth weight
-Neonatal acidosis (arterial pH <7.10 + EB> 12 mEq / L)
-Perinatal mortality (> 22 weeks gestation, <28 days postpartum)
-Days in the Neonatal Intensive Care Unit
-Significant neonatal morbidity (convulsions, intraventricular hemorrhage> grade III, periventricular leukomalacia, hypoxic-ischemic encephalopathy, abnormal electroencephalogram, necrotizing enterocolitis, acute renal failure (serum creatinine> 1.5 mg / dl) or heart failure (requiring inotropic agents). |
-Índice de pulsatilidad medio de las arterias uterinas a las 28 semanas
-Preeclampsia: tensión arterial diastólica (TAD) >=90 mmHg) y o sistólica (TAS) > = 140 mmHg en dos determinaciones separadas > 4h + proteinuria > 300 mg/24h.
-Edad gestacional debut de la preeclampsia
-Preeclampsia grave: criterios de preeclampsia + TAD > = 110 mmHg , proteinuria > 5g/24h, oligouria (<400 ml/24h), clínica neurológica (cerebrales o visuales), edema agudo de pulmón (criterio radiológico y gasométrico), dolor epigástrico persistente, alteración de la función hepática (AST o ALT > 70 UI), signos analíticos de hemólisis (LDH>700 U/L) y/o trombocitopenia (<100.000/ml).
-Edad gestacional al parto (parto prematuro: antes de las 34 semanas de gestación).
-Retraso de crecimiento intrauterino: peso neonatal inferior al percentil 10 de nuestra población + índice de pulsatilidad en la arteria umbilical durante el tercer trimestre (en dos ocasiones separadas > 48h) superior al percentil 95.
-Cesarea urgente por pérdida de bienestar fetal.
-Peso neonatal
-Acidosis neonatal (pH arterial <7.10 + EB > 12 mEq/L)
-Mortalidad perinatal (>22 semanas de gestación-<28 días posparto)
-Días estancia en la Unidad de Cuidados Intensivos Neonatales
-Morbilidad neonatal significativa (convulsiones, hemorragia intraventricular > grado III, leucomalacia periventricular, encefalopatía hipóxico-isquémica, electroencefalograma anormal, enterocolitis necrotizante, fallo renal agudo (creatinina sérica >1,5 mg/dl) o fallo cardiaco (requiriendo agentes inotrópicos) |
|
E.5.2.1 | Timepoint(s) of evaluation of this end point |
|
E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | Yes |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 3 |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
|
Last visit of the last subject (LVLS) |
Última visita al último paciente. |
|
E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 0 |
E.8.9.1 | In the Member State concerned months | 14 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 0 |
E.8.9.2 | In all countries concerned by the trial months | 14 |
E.8.9.2 | In all countries concerned by the trial days | 0 |