Monitoring women at risk for preterm labor.
BACKGROUND
Preterm birth is a major cause of perinatal morbidity and mortality. Whether the rate of preterm birth can be reduced by frequent contact between nurses and pregnant women or home monitoring of uterine activity is not known.


METHODS
We randomly assigned 2422 pregnant women with known risk factors for preterm labor (including 844 women who were pregnant with twins) to receive education and to have one of the 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 birth at less than 35 weeks' gestation. Secondary end points included cervical status at the time preterm labor was diagnosed and birth weight.


RESULTS
There were no significant differences among the groups in the incidence of birth at less than 35 weeks (14 percent in the weekly-contact 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 than 1500 g or less than 2500 g. However, daily contact with a nurse increased 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 prophylactic tocolytic drugs (12 percent, 14 percent, and 19 percent, respectively).


CONCLUSIONS
Women who have daily contact with a nurse, with or without home monitoring of uterine activity, have no better pregnancy outcomes than women who have weekly contact with a nurse.
Dyson
D C
DC
Department of Obstetrics and Gynecology, Kaiser Permanente Medical Care Program, Northern California, Santa Clara 95051-5386, USA.
Danbe
K H
KH
Bamber
J A
JA
Crites
Y M
YM
Field
D R
DR
Maier
J A
JA
Newman
L A
LA
Ray
D A
DA
Walton
D L
DL
Armstrong
M A
MA
D000328:Adult; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006699:Home Care Services; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D018709:Statistics, Nonparametric; D015149:Tocolytic Agents / Q000627:therapeutic use; D018590:Uterine Monitoring
D015149:Tocolytic Agents