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Evidence summaries

Home Uterine Activity Monitoring for Detection of Preterm Labour

Home uterine activity monitoring appears not to be effective in improving infant morbidity and mortality compared with conventional care in women at high risk of preterm birth. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding and incomplete outcome data in half of the trials).

A Cochrane review [Abstract] 1 included 15 studies with a total of 6008 subjects. Women at high risk of preterm birth were randomly assigned to home uterine monitoring (one- to two-hour periods each day) or conventional care. Monitoring results were transmitted daily by modem to a base centre for interpretation by a midwife or doctor. There was no significant difference in the rate of perinatal mortality (RR 1.22, 95% CI 0.86 to 1.72; 2 studies, n=2589) between the home monitoring group vs conventional care group. Women using home uterine monitoring were less likely to experience preterm birth at less than 34 weeks (RR 0.78, 95% CI 0.62 to 0.99; 3 studies, n=1596). However, this difference was not evident when restricting the analysis to studies at low risk of bias based on study quality (RR 0.75, 95% CI 0.57 to 1.00; 1 study, n=1292 women). There was no significant difference in the number of preterm births at less than 37 weeks (average RR 0.85, CI 0.72 to 1.01; 8 studies, n=4834; I² 68%). Infants born to women using home uterine monitoring were less likely to be admitted to neonatal intensive care unit (average RR 0.77, 95% CI 0.62 to 0.96; 5 studies, n=2367; I² 32%). However, this difference was not statistically significant when only high quality studies were included (RR 0.86, 95% CI 0.74 to 1.01; 1 study, n=1292). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.49, 95% CI 0.39 to 0.62; 2 studies, n=2807) and were more likely to have prophylactic tocolytic drug therapy (average RR 1.21, 95% CI 1.01 to 1.45; 7 studies, n=4316; I² 62%) but this difference was no longer significant when the analysis was restricted to high quality studies (average RR 1.22; 95% CI 0.90 to 1.65, 3 studies, n=3749, I² 76%).

    References

    • Urquhart C, Currell R, Harlow F et al. Home uterine monitoring for detecting preterm labour. Cochrane Database Syst Rev 2017;(2):CD006172. [PubMed]

Primary/Secondary Keywords