MONITORING WOMEN AT RISK FOR PRETERM LABOR

Background Preterm birth is a major cause of perinatal morbidity and m ortality. Whether the rate of preterm birth can be reduced by frequent contact between nurses and pregnant women or home monitoring of uteri ne activity is not known. Methods We randomly assigned 2422 pregnant w omen with known risk factors for preterm labor (including 844 women wh o were pregnant with twins) to receive education and to have one of th e following: weekly contact with a nurse, daily contact with a nurse, or daily contact with a nurse and home monitoring of uterine activity. The nurses elicited the women's own assessments of their symptoms and signs of preterm labor. The primary end point was the incidence of bi rth at less than 35 weeks' gestation. Secondary end points included ce rvical status at the time preterm labor was diagnosed and birth weight . Results There were no significant differences among the groups in th e incidence of birth at less than 35 weeks (14 percent in the weekly-c ontact group, 13 percent in the daily-contact group, and 14 percent in the home-monitoring group), in the mean amount of cervical dilatation at the time preterm labor was diagnosed (1.8 cm, 1.5 cm, and 1.4 cm, respectively), or in such neonatal outcomes as birth weights of less t han 1500 g or less than 2500 g. However, daily contact with a nurse in creased the mean number of unscheduled visits to obstetricians (1.2 in the weekly-contact group, 1.8 in the daily-contact group, and 2.3 in the home-monitoring group) and the proportion of women who received pr ophylactic tocolytic drugs (12 percent, 14 percent, and 19 percent, re spectively).Conclusions Women who have daily contact with a nurse, wit h or without home monitoring of uterine activity, have no better pregn ancy outcomes than women who have weekly contact with a nurse. (C) 199 8, Massachusetts Medical Society.