Monitoring pregnant women at home for detecting preterm labour

Cochrane: Babies who are born too early are more likely to become ill or die. If preterm labour is detected, treatment can start to slow down or stop labour. This also gives time for treatment to improve the baby’s breathing at birth. Increased contractions can be a sign of labour starting early. Many women do not recognise these contractions in time for treatment. Pregnant women at risk of giving birth early could use a monitoring device at home. This would send data to the hospital, and help doctors and midwives to detect and treat preterm labour.

What evidence did we find?
We searched for evidence on 28 June 2016 and found 15 randomised studies, involving 6008 women. Thirteen of these studies provided data we could use. The quality of results ranged from very low to high (GRADE). Most studies had design limitations, which in some were serious. Most studies compared women taught how to check for signs of premature labour with women who were also given a home uterine activity monitor. In some studies both groups used a monitor but one group had a ‘sham’ monitor that did not actually send the data to the women’s healthcare providers.Using a monitor at home made very little difference to many of the outcomes for mother or baby, although not all studies measured all outcomes. Women using monitors were no less likely to experience preterm birth at less than 37 or 32 weeks of pregnancy (GRADE very low). Women using monitors were less likely to experience preterm birth at less than 34 weeks, but when we analysed only high-quality studies, no clear difference remained (GRADE high). Babies born to women using the monitor were less likely to be admitted to neonatal intensive care (GRADE moderate) but there were no fewer deaths (GRADE low). Women using the monitor were more likely to make an unscheduled antenatal visit (GRADE moderate), but the number of antenatal hospital admissions did not differ (GRADE low). Women using monitors appeared to be more likely to receive tocolysis (treatment to stop labour) (GRADE low), but when we looked only at high-quality studies there was no clear difference. We found no data to assess women's views, although one large trial reported low compliance with monitor use. In some studies, women with monitors had more contact with midwives or maternity nurses, but it is unclear what effect this had.
What does this mean?
Home uterine monitoring may result in fewer admissions to a neonatal intensive care unit, but more unscheduled antenatal visits and treatment for preterm labour. The level of evidence is generally low to moderate.

Authors' conclusions: 

Home uterine monitoring may result in fewer admissions to a neonatal intensive care unit but in more unscheduled antenatal visits and tocolytic treatment; the level of evidence is generally low to moderate. Important group differences were not evident when we undertook sensitivity analysis using only trials at low risk of bias. There is no impact on maternal and perinatal outcomes such as perinatal mortality or incidence of preterm birth.