HOME UTERINE ACTIVITY MONITORING IN THE PREVENTION OF VERY-LOW-BIRTH-WEIGHT

Objectives. Despite controversy regarding the efficacy of home uterine activity monitoring (HUAM), it is currently licensed for detection of preterm labor in women with previous preterm deliveries. In practice, however, it is being more widely utilized in an effort to prevent pre term delivery. This study seeks to determine which group of mothers de livering very low birth weight (VLBW) infants would have qualified for HUAM given three different sets of criteria and in which women ii cou ld have been used to help prolong gestation. Methods. The authors revi ewed the medical records of mothers of VLBW infants born in five U.S, locations (N=1440), retrospectively applying three sets of eligibility criteria for HUAM use: (a) the current FDA licensing criterion for us e of HUAM, a previous preterm birth; (b) indications for HUAM commonly cited in published reports; (c) a broad set of criteria based on the presence of any reproductive or medical conditions that might predispo se to premature delivery. The authors then analyzed the conditions pre cipitating delivery for each group to determine whether delivery might have been prevented with HUAM and tocolytic therapy. Results. Only 4. 4% of the total group of women delivering VLBW infants would have been eligible for HUAM under the FDA criterion and might potentially have benefited from this technology. if extremely broad criteria had been a pplied to identify those eligible for monitoring, under which almost 8 0% of ail women who delivered VLBW infants would have been monitored, only 20.3% of the total group would have been found eligible and would potentially have benefited. If such broad criteria were applied to al l pregnant women, a sizable proportion of pregnancies would be monitor ed at great expense with small potential clinical benefit. Conclusions . Because VLBW births are usually precipitated by conditions that are unlikely to benefit from HUAM, this technology will have little impact on reducing VLBW and neonatal mortality rates. More comprehensive pre ventive strategies should be sought.