[Home care for preterm labor].
OBJECTIVE
To analyze the different modalities of home care management for women hospitalized for preterm labor.


METHODS
We reviewed all reports in French and English on Medline using the following key-words: home uterine activity monitoring, home care management, midwives follow-up. Reports were categorized by level of proof (LP 1 to 5). For each study, method, results and authors'conclusions were recorded. We gave our comments for each report.


RESULTS
We could not find any report concerning indications of leaving hospital after treatment for preterm labor. We only could find expert recommendations. Concerning home uterine activity monitoring, the results demonstrated that there were no arguments to recommend this method for early detection of preterm labor or to avoid preterm delivery. Most of these studies had weak power and multiple methodological biases. Very few studies reported about home care midwives follow-up. Some rare randomized studies demonstrated the non efficient effect of this management on the reduction of prematurity rates. The rates of hospitalization did not decrease. Conversely, patients satisfaction was increased.


CONCLUSIONS
Home uterine activity monitoring seems to be unnecessary, having no incidence on early diagnosis of preterm labor or rates of prematurity (LP2 or 3). Home care follow-up by midwives for patients treated for preterm labor did not reduce rates of prematurity (LP1). It slightly increased the women's satisfaction.
Dreyfus
M
M
Service de Gynécologie-Obstétrique et Médecine de la Reproduction, CHU, avenue Clémenceau, 14033 Caen Cedex, France. dreyfus-m@chu-caen.fr
Durin
L
L
D005260:Female; D005602:France; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care; D018590:Uterine Monitoring