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Home Fetal Monitoring to Prevent Pre-term Birth

Reading & Recommendations

(Last review: 2004)

A number of studies have suggested that pregnant women should routinely count the movements of their baby at set times each day between 26 and 36 weeks of pregnancy. The counting of fetal movements detects a change in activity that could predict problems with the baby that might lead to early labor. Distress in the baby could allow early use of drugs to stop early labor. Since 6% of all births occur before 36 weeks of pregnancy and these early births account for a high percentage of both deaths in newborn infants as well as nervous system damage to babies, it is desirable to reduce the number of pre-term births.

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

Other Recommendations

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. 

Selected Bibliography

  1. Iams JD, Johnson FF, O'Shaughnessy RW, et al. A prospective random trial of home uterine activity monitoring in pregnancies at increased risk of pre-term labor. Am J Obstet Gynecol 1987; 157: 638-643.
  2. Dyson DC, Crites YM, Ray DA, et al. Prevention of pre-term birth in high risk patients: The role of education and provider contact versus home uterine monitoring. A, J Obstet Gynecol 1991; 164: 756-762.
  3. Mou SM, Sunderji SG, Gall S, et al. Multicenter randomized clinical trial of home uterine activity monitoring for detection of preterm labor. Am J Obstet Gynecol 1991; 165: 858-866.
  4. Corwin MJ, Mou SM, Sunderji SG, et al. Multi center randomized clinical trial of home uterine activity monitoring: pregnancy outcomes for all women randomized. Am J Obstet Gynecol 1996;175:1281-1285. 5.Dyson DC, Danbe KH, Bamber JA, et al. Monitoring women at risk for pre-term labour. N Engl J Med.1998; 338:54-56.
  5. Morrison JC, Martin JN Jr, Martin RW, et al. A program of uterine activity monitoring and its effect on neonatal morbidity. J Perinatol 1998; 8: 228-231.
  6. Dyson DC, Danbe KH, Bamber JA et al Monitoring women at risk for pre term birth. N Eng J Med 1998;338:54-56.
  7. Moninex BE, Zondervan WM, Bossuyt PM et al. cost minimization analysis of domicilliary antenatal fetal monitoring in high risk pregnancies. Obstet Gynecol 1997;89:925-929.<
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