A randomized clinical trial of care for women with preterm labour: home management versus hospital management

Background: Preterm labour occurs in about 10% of all pregnancies and is th e most important cause of premature birth. Women with preterm labour are ad mitted to hospital to have the contractions stopped. Thereafter, many women remain in hospital until delivery. We conducted a randomized clinical tria l to compare hospital care with home care of women who had been admitted to hospital for preterm labour. Methods: After they had received treatment for an acute episode of prematur e labour, women at 2 regional perinatal centres associated with teaching ho spitals were randomly assigned to home care or hospital care. Eligible wome n (n = 250) were aged 18 years or older, lived within 50 km of the hospital , had a gestational age between 20 and 35 weeks, had no prior preterm deliv ery and were experiencing their first episode of preterm labour and first a dmission to hospital for preterm labour. Analysis was by intention to treat . Results: There were no significant differences between the 2 groups in mean gestational age at delivery (home: 37.52 weeks, hospital: 37.50 weeks) or in mean birth weight (home: 2974 g, hospital: 3020 g). There were no signif icant differences between the 2 groups with respect to the proportions of b abies born before term or the mean duration of neonatal hospital stay, neon atal intensive care unit stay and intermediate care nursery stay. The mean duration of the first stay in hospital for the women in the home group (3.8 days) was significantly shorter than the mean duration for women in the ho spital group (6.1 days). In addition, the mean duration of all maternal sta ys in hospital was significantly shorter for the women in the home group (3 .7 days) than in the hospital group (5.0 days). Interpretation: Home care management is an efficient and acceptable alterna tive to hospital care for women experiencing preterm labour.