A validation study of home uterine activity monitoring technology in Western Australia

Uterine contraction assessment

Few approaches to preterm birth prevention have been as thoroughly studied yet as enigmatic as uterine contraction assessment. Despite multiple randomized clinical trials (level 1 evidence), the effectiveness of home uterine contraction assessment as an adjunct to the clinical management of women at risk for preterm birth remains controversial. This article reviews these trials with particular attention to study design and patient inclusion criteria. The data are absolutely clear that home uterine contraction monitoring with or without frequent perinatal nursing contact can reduce the risk of preterm birth and improve perinatal outcomes and that both are independently superior to standard preterm birth prevention education and care.

Current status of home uterine activity monitoring

A comprehensive evidence-based review of the clinical data leads to the conclusion that if patients at high risk for preterm birth (eg, prior preterm birth because of preterm labor, twins and higher-order multiple gestation, women who have preterm labor during the current pregnancy tocolyzed effectively) use the comprehensive system of HUAM correctly (ie, daily nursing care and twice-daily monitoring) with appropriate alarm rates and sensitive monitors, the incidence of early diagnosis of preterm labor, effective prolongation of pregnancy with fewer preterm births, and a reduction in neonatal morbidity is always demonstrated when the study group is compared with a control group consisting of women receiving standard care available to obstetricians in the United States. The authors expect that there will always be arguments regarding whether the monitor or the nurse contributes most to preterm birth reduction. Even when the alerts of detected contractions or patient-reported symptoms are sounded, the issue of prompt and effective medical intervention will always be hotly debated. The appropriate research design that tests HUAM while allowing various diagnostic and treatment modalities that physicians employ around the United States must be individualized. Physicians must make the decision, based on the evidence, regarding whether or not this system would benefit their patients. While investigators argue about research designs and statistical analyses, physicians simply want the best outcomes for their patients, which is what women and the whole of society also want. Based on the available evidence, it is clear that when the comprehensive system of HUAM is used appropriately in the right patients, everyone benefits.