A randomized comparison of home uterine activity monitoring in the outpatient management of women treated for preterm labor

OBJECTIVE: The aim of the study was to evaluate home uterine activity monit oring as an intervention in reducing the rate of preterm birth among women treated for preterm labor. STUDY DESIGN: A total of 186 women were treated in the hospital with magnes ium sulfate for preterm labor and were prospectively randomly assigned to s tudy groups; among these, 162 were ultimately eligible for comparison. Eigh ty-two of these women were assigned to the monitored group and 80 were assi gned to an unmonitored control group. Other than monitoring, all women rece ived identical prenatal follow-up, including daily perinatal telephone cont act and oral terbutaline therapy. Outcome comparisons were primarily direct ed toward evaluation of preterm birth at <35 weeks' gestation. Readmissions for recurrent preterm labor and observations lasting <24 hours were evalua ted in monitored and unmonitored groups. Compliance with monitoring was als o evaluated in the monitored group. RESULTS: The monitored and control groups were demographically similar. Acc ording to a multivariate logistic regression model, women with cervical dil atation of greater than or equal to 2 cm were 4 times more likely to be del ivered at <35 weeks' gestation (P<.05). Gestational ages at delivery were s imilar in the monitored and control groups. There was no significant differ ence in the overall rate of preterm delivery at <35 weeks' gestation betwee n the monitored group (10.9%) and the control group (15.0%). The overall ra tes of delivery at <37 weeks' gestation were high (48.8% and 60.0% for moni tored and control groups, respectively), and the difference was not signifi cant. The numbers of women with greater than or equal to 1 instance of read mission and treatment for recurrent preterm labor were equal in the monitor ed and control groups. The numbers of women with greater than or equal to 1 hospital observation lasting <24 hours were not different between the grou ps. Compliance with monitoring did not significantly differ for women who w ere delivered at <35 weeks' gestation, women with greater than or equal to 2 cm cervical dilatation at enrollment, or for African American women. CONCLUSION: A reduction in the likelihood of preterm delivery at <35 weeks' gestation was not further enhanced by the addition of home uterine monitor ing to the outpatient management regimens of women treated for preterm labo r.