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Induction of Labor Affected Fetus / NewbornNCT06325007

Castor Oil Ingestion and Balloon Catheter for Labor Induction in Nulliparous

A study testing Induction of labor in people with Induction of Labor Affected Fetus / Newborn, run by Holy Family Hospital, Nazareth, Israel at 2 sites in Israel.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this randomized controlled trial is to examine the efficacy of combining castor oil ingestion with extra-amniotic single balloon catheter for cervical ripening on time from induction to delivery in nulliparous women. Read more about this study

Who is it for?
Ages 18 to 60 years, women onlyHealthy volunteers can take part
What is being tested?
Induction of labor
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
142 participants
Where
2 sitesIsrael
Study dates
11 Apr 2024to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 60 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Women above 18 years old
  • Sign an informed consent
  • Term pregnancy (>37 weeks)
  • Viable fetus
  • Singleton
  • Vertex presentation
  • Intact membranes
  • Cervix with Bishop score ≤6

Who cannot join

  • Previous cesarean delivery
  • Major fetal malformations
  • Contraindication to spontaneous vaginal delivery
  • Amniotic fluid index >25cm
  • Chorioamnionitis at admission
  • Placental abruption
Show all 11Show fewer
  • Previous prostaglandin use for induction of labor
  • A low-lying placenta (up to 2 cm from the internal os)
  • Carriers of hepatitis B or C or human immunodeficiency viruses
  • Women with a history of allergy to latex.
  • Women with a history of allergy to castor oil

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Raed Salim, MD contact

+972544986960

r.salim@hfhosp.org

Israel2 sites, 2 recruiting
  • Holy Family hospital, Nazareth

    Nazareth

    Wiaamk Khatib, MD, 0549192433, wiaam.khatib.95@gmail.com

    Wiaam Khatib, MD

    Not yet recruiting
  • Holy Family Hospital

    Nazareth

    Raed Salim, MD, r.salim@hfhosp.org

    Recruiting

Other trials in Israel

About this study

Official title: The Effect of Combining Single Balloon Catheter With Castor Oil Ingestion for Cervical Ripening on Time to Delivery Among Nulliparous Women.

The goal of this randomized controlled trial is to examine the efficacy of combining castor oil ingestion with extra-amniotic single balloon catheter for cervical ripening on time from induction to delivery in nulliparous women.

The main question it aims to answer are:

Does the addition of the use of castor oil to extra-amniotic single balloon reduce the time until birth? Does the addition of the castor oil affect other perinatal outcomes during childbirth? Are the side effects of the castor tolerated by the mothers? Participants will be randomly divided into 2 groups: the study group will drink a mixture of 60 ml of castor oil mixed with 140 ml of orange juice. Thirty minutes later, an extra-amniotic single balloon catheter will be inserted above the internal cervical os and filled with 60 mL of normal saline. In the control group, a foley catheter will be inserted into cervical canal without ingestion of castor oil.

Read the detailed description

The rate of labor induction has increased up to 25.7% in 2018 for several demographic and obstetric reasons. In nulliparous women the reported rate is nearly 32%.

Various methods are used to induce labor worldwide, including natural, mechanical and pharmacological agents. of all methods balloon catheters were proven to cause fewer adverse perinatal events.

Though induction is considered a safe and effective procedure, it may lead to a prolonged labor which is associated with complications such postpartum hemorrhage, infection, and operative delivery.

Based on these data several studies have examined the combinations of balloon catheters with other pharmacological agents on labor durations. The results were inconsistent, and several reports showed that the combination reduced significantly the length of labor. Nevertheless, pharmacological agents may be associated with adverse events including uterine hyperstimulation, placental abruption, and postpartum hemorrhage, though the overall risk is small.

Castor oil, extracted from the seeds of Ricinus communis plant, is a natural effective substance for induction of labor. it's considered a safe and inexpensive though the exact mechanism by which it induces labor is still unclear.

Our hypothesis suggests that ingestion of castor oil combined with the balloon catheter will shorten the time to delivery. In order to show a reduction by 3 hours, a sample size of 57 in each group will be needed assuming 80% power and a two-tailed alpha of 5%.

Since the success rate of vaginal delivery is nearly 85%, the sample size was calculated to 67 women in each group. Additional 5% are planned to be recruited to account for trial drop out for any reason, yielding a total final sample size of 71 women in each group (142 in both groups).

Being tested
Induction of labor

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Induction of laborDietary supplement

    The study group only will drink a mixture of 60 ml of castor oil mixed with 140 ml of orange juice. Thirty minutes later, in both groups, an extraamniotic single balloon catheter will be inserted above the internal cervical os and filled with 60 mL of normal saline. Following removal, artificial rupture of the membranes will be performed as long as it is safe with regards to fetal head position. Oxytocin infusion will be commenced at once if contraction has not begun spontaneously (2 to 3 regular uterine contractions per 10 minutes). Continuous electronic fetal monitoring will be used throughout labor. Labor will be managed by the attending obstetricians and midwives. Labor progress abnormalities will be diagnosed and managed according to the department protocol based on the recommendations of the American College of Obstetricians and Gynecologists.

Study groups in NCT06325007
Study groupRoleWhat they receive
group 1 - study groupActive comparatorCandidates will drink a mixture of 60 ml of castor oil and 140 ml of orange juice. 30 minutes later, A 22-French Foley catheter will be inserted above internal cervical os and will be filled with 60 mL of normal saline.
Receives: Dietary Supplement: Induction of labor
group 2- controlActive comparatorA foley catheter will be inserted into cervical canal as described above according to the department protocol without ingestion of castor oil.
Receives: Dietary Supplement: Induction of labor

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. time to delivery

    Time from catheter insertion to vaginal delivery.

    Measured: 48 hours

Secondary outcomes (32)
  1. balloon expulsion time

    The time until balloon was spontaneously expelled

    Measured: 12 hours after insertion

  2. Bishop score after catheter expulsion

    Bishop score after removal of the catheter where a high score (above 7) indicates a better outcome.

    Measured: 12 hours

  3. Fetal presentation at the delivery

    The insertion of a balloon may lead to a change in the presenting part of the fetus. A change to a non-vertex presentation is carried as an undesired outcome.

    Measured: 48 hours

  4. Duration of the active phase of labor

    Duration of the time from 6 cm cervical dilatation to 10 cm cervical dilatation

    Measured: 4 hours

  5. Duration of second stage

    the time from 10 cm cervical dilatation until the delivery of the baby

    Measured: 4 hours

  6. Mode of delivery

    Whether the birth was a normal spontaneous birth, operative vaginal birth or a cesarean section.

    Measured: 48 hours

  7. Indications for cesarean or operative vaginal deliveries

    Was the reason for operative vaginal delivery or cesarean delivery due to non progress labor, fetal status, or a combination of both?

    Measured: 48 hours

  8. Intrapartum fever

    Number of patients that will have intrapartum fever ≥ 38 °C

    Measured: 48 hours

  9. Number of patients that will require use of intrapartum use of antibiotic treatment.

    Number of patients that will require use of intrapartum use of antibiotic treatment due to intrapartum infection.

    Measured: 48 hours

  10. Number of Participants with that will develop clinical signs of chorioamnionitis.

    Clinical signs of chorioamnionitis includes abdominal tenderness, abnormal discharge, intrapartum fever, tachycardia

    Measured: 48 hours

  11. Number of Participants with that will develop 3rd and 4th degrees perineal lacerations.

    Obstetric anal sphincter injury

    Measured: 48 hours

  12. Number of Participants with develop postpartrum hemorrhage.

    early postpartum hemorrhage (PPH)

    Measured: 48 hours

  13. Number of Participants with need blood transfusion.

    PPH that required blood transfusion

    Measured: 72 hours

  14. Side effects related to castor oil use

    nausea, vomiting, uterine hyperstimulation> the 5 contractions: 10 minutes

    Measured: 48 hours

  15. Oxytocin maximal dosage

    Oxytocin maximal dosage

    Measured: 48 hours

  16. Number of participants with Umbilical Cord prolapse.

    Umbilical cord prolapse is when the umbilical cord exits the cervical os before the fetal presenting part that may result in fetal hypoxia.

    Measured: 48 hours

  17. Apgar score (0 to 10).

    APGAR< 7 after 1 and 5 minutes where lower scores mean a worse outcome.

    Measured: 48 hours

  18. pH taken from umbilical artery

    Cord artery pH <7.1

    Measured: 48 hours

  19. Neonatal birthweight

    Neonatal birthweight

    Measured: 48 hours

  20. Number of neonates with Neonatal fever ≥ 38 °C

    Neonatal fever >38

    Measured: 72 hours

  21. The number of neonates that will develop neonatal sepsis.

    Diagnosis of neonatal sepsis based on clinical signs of sepsis and positive cultures.

    Measured: 72 hours

  22. The number of neonates that will require antibiotic treatment.

    Need for antibiotic treatment

    Measured: 72 hours

  23. Neonatal complications

    respiratory distress syndrome, transient tachypnea of newborn, intracranial hemorrhage, intraventricular hemorrhage, seizures, Meconium aspiration syndrome ,Hypoxic ischemic encephalopathy

    Measured: 48 hours

  24. The number of neonates that will Admit to neonatal intensive care unit (NICU)

    Neonatal admission to NICU

    Measured: 30 days

  25. Length of stay in NICU.

    Neonatal length of stay in NICU.

    Measured: 30 days

  26. neonatal death

    neonatal death

    Measured: 30 days

  27. Maternal hemoglobin level after delivery.

    higher level of Hemoglobin and indicate better outcome.

    Measured: 48 hours

  28. Number of participants that will require postpartum hysterectomy.

    Maternal hysterectomy

    Measured: 72 hours following delivery.

  29. Number of participants that will require postpartum laparotomy.

    Number of participants that will require postpartum laparotomy after vaginal delivery or re-laparotomy after cesarean section.

    Measured: 72 hours following delivery.

  30. postpartum maternal complications

    endometritis

    Measured: 72 hours following the delivery.

  31. The length of stay from birth to discharge home.

    The length of stay in days from birth to discharge home.

    Measured: up to 10 days

  32. Maternal satisfaction from delivery process.

    1 = Very dissatisfied, 10 = Very satisfied

    Measured: up to 10 days after delivery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Mar 2024
  2. Study start11 Apr 2024
  3. Primary completion15 Nov 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
142 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06325007
Sponsor's protocol ID
293-2024-HFH
Status last verified
Apr 2026
First submitted
5 Mar 2024
Last updated
13 Apr 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: IPD that underlie results in a publication

Publications

  • 1.Clinical management guidelines for Obstetrician-Gynecologists. The American College of Obstetricians and Gynecologists 2009. Vol.114, No.2, Part1. 2. Grobman W, et al. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. The new England journal of medicine 2018;379;6. 3. Jones MN,et al. Balloon catheters versus vaginal prostaglandins for labour induction (CPI Collaborative): an individual participant data meta-analysis of randomised controlled trials. Lancet 2022;400:1681-1692. 4. Cheng YW, et al. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor. Am J Obstet Gynecol. 2009;201:477.e1-7. 5. Cheng YW, et al. Length of the first stage of labor and associated perinatal outcomes in nulliparous women. Obstet Gynecol 2010;116:1127-35. 6. Gagnon J, et al. Intracervical Foley catheter with and without oxytocin for labor induction with Bishop score ≤3: a secondary analysis. Am J Obstet Gynecol MFM 2021;3:100350. 7. Edwards RK, et al. Controlled Release Dinoprostone Insert and Foley Compared to Foley Alone: A Randomized Pilot Trial. Am J Perinatol 2021;38:e57-e63. 8. DeMariaa A, et al. Castor oil as a natural alternative to labor induction: A retrospective descriptive study. Women and Birth 2018;31:e99-e104. 9. Moradi M, et al. Effect of Castor Oil on Cervical Ripening and Labor Induction: a systematic review and meta-analysis. Journal Of Pharmacopuncture 2022;25:71-78. 10. Shalev-Ram H, et al. Is there a difference in labor patterns after induction with prostaglandins and double-balloon catheters? American Journal of Obstetrics and Gynecology 2023;3:100198. 11. Tunarua S, et al. Castor oil induces laxation and uterus contraction via ricinoleic acid activating prostaglandin EP3 receptors. Proceedings of the National Academy of Sciences 2012. 12. Kelly AJ, et al. Castor oil, bath and/or enema for cervical priming and induction of labour. Cochrane Database Syst Rev 2013;2013:CD003099. 13. Bayoumi YA, et al. Castor oil for labor initiation in women with a previous cesarean section: a double-blind randomized study. J Matern Fetal Neonatal Med 2022;35:8945-8951. 14. Gilada R, et al. Castor oil for induction of labor in post-date pregnancies: A randomized controlled trial. Women and Birth 2018;e26-e31. 15. Salim R, et al. Single-balloon compared with double-balloon catheters for induction of labor: a randomized controlled trial. Obstet Gynecol 2011;118:79-86. 16. American College of Obstetricians and Gynecologists (College); Society for Maternal-Fetal Medicine; Caughey AB, et al. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014;210:179-93.

Questions about this trial

What is this clinical trial studying?

A study testing Induction of labor in people with Induction of Labor Affected Fetus / Newborn, run by Holy Family Hospital, Nazareth, Israel at 2 sites in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 13 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Raed Salim, MD (+972544986960, r.salim@hfhosp.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

time to delivery (time frame: 48 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06325007, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Apr 2026.

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