Home Fetal Monitoring to Prevent Pre-term Birth
Reading & Recommendations
(Last review: 2004)
The method of uterine activity monitoring that is recommended includes detailed instructions for the woman on how to feel and count the baby's activities. The woman is asked to count the baby's movements for between 5 and 20 minutes two to four times daily and then report the number of movements counted. If the movements are found to either change pattern or increase above a predetermined level the woman is asked to rest by lying on her side and to drink extra amounts of fluid. She is also asked to monitor fetal movements more frequently. If the movements do not return to normal with this treatment the woman would be admitted to hospital for further management.
There have been four randomized controlled trials to measure the benefit of fetal movement monitoring to prevent early labor and premature delivery of small infants. Each study involved a small number of women and was flawed in designed making it difficult to draw conclusions. One of the main problems with the study design was that the women not using home uterine monitoring in the studies received much less medical contact and attention than the women who reported uterine activity daily. Two of the four studies found that the woman participating in home fetal monitoring had the same number of pre-term births as those not participating .1, 2 In the other two trials the participating women had slightly fewer pre term births than the women in the control group.3, 4 All the studies found that the procedure was both demanding and expensive costing between $7,000 and $12,000 for each pregnancy.
A review of the literature since 1996 finds no new studies on home maternal monitoring in normal risk pregnancies. Several studies in women at risk for pre term birth have had mixed results. An American study found definite benefit in outcomes in women at high risk of pre term births.4 Another American Study found no benefit to home monitoring.5 The high cost and equivocal results especially in low risk pregnancy continue to make this a questionable procedure. In women at risk of premature delivery one study has found no particular benefit from daily vs weekly nursing visits to assess fetal activity.6 A Dutch study has found that using telemetric monitoring of high risk women at home is equally as effective as in hospital and considerably less expensive. This procedure will only be possible where such capacity exists.7
The Canadian task force on the periodic health examination and the U.S preventive services task force both give H.U.A.M. a "D" recommendation for normal pregnancy and a "C" recommendation for pregnancy considered at high risk for premature births.