Article Abstract:
Preterm birth, the delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Despite advances in perinatal medicine, preterm delivery continues to be a leading cause of illness and death during the delivery and neonatal period. Preterm birth prevention involves identifying women at risk for preterm delivery, diagnosing preterm labor as early as possible and arresting labor with tocolytic drugs so that pregnancy can be effectively prolonged. Programs designed to teach women the signs and symptoms of preterm labor have yielded mixed results. It is thought that these programs are lacking information regarding the frequency and validity of uterine contractions. A new home monitoring system measures, records and transmits patterns of uterine contractions via the telephone, which are then interpreted by nursing specialists available 24 hours a day. The value of home monitoring was evaluated in women at risk for early delivery. Women were assigned to receive home monitoring plus daily nursing support (155 women) or a standard program of care involving intensive education and frequent prenatal visits (144 women). The patients receiving home monitoring combined with daily nursing contact were diagnosed with preterm labor earlier (when the cervix was less than two centimeters dilated), had more successful tocolysis (pharmacological arrest of preterm delivery), and could carry the pregnancy to term more often than the women receiving standard prenatal care. The diagnosis of preterm labor was made more often in the monitored group (31 percent) than in the group relying on patient-perceived signs and symptoms. It is concluded that detection of preterm labor can be achieved earlier if a home monitoring system combined with nursing support is added to preterm prevention programs. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Preterm birth, delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. Since preterm labor is a major cause of preterm delivery, efforts to reduce preterm birth are aimed at diagnosing preterm labor as early as possible. The earlier preterm labor is diagnosed, the more effective management strategies will be. Women at risk for early delivery experience more uterine contractions than women whose labor comes at the end of a normal term (40 weeks) of pregnancy. True labor is marked by regular uterine contractions and progressive changes in the character of the cervix (thinning and dilating). It is not clear whether the uterine contraction rate is useful in predicting subsequent events and impending labor. Patient-perceived signs and symptoms of contractions are often unreliable. The rate of contractions can be measured using a home monitoring device known as an ambulatory tocodynamometer, which measures, records and transmits patterns of uterine contractions via the telephone to perinatal nurses twice a day. The relationship between uterine contractions measured by a home monitoring system and subsequent preterm labor was studied among 105 patients at risk for early delivery. Women experiencing four or more contractions per hour on an initial and repeat monitor tracings accompanied by changes in the cervix were diagnosed with preterm labor. Of the 49 patients (47 percent) diagnosed with preterm labor, 28 were correctly predicted by increased frequency of contractions on repeated monitor tracings. Therefore, 70 percent of the patients were correctly classified. An initial and repeat monitor tracing demonstrating four or more contractions per hour was useful in identifying women at risk for early labor. (Consumer Summary produced by Reliance Medical Information, Inc.)
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Article Abstract:
Despite advances in perinatal medicine, preterm delivery continues to be a leading cause of illness and death during the delivery and neonatal period. Preterm birth prevention involves identifying women at risk for preterm delivery, diagnosing preterm labor as early as possible and arresting labor with tocolytic agents so that pregnancy can be effectively prolonged. Preterm prevention programs involve frequent examinations of high-risk women to detect uterine contractions and cervical dilation. The reliability of these assessment tools for the earliest diagnosis has been questioned. A new home monitoring system known as an ambulatory tocodynamometer measures, records and transmits patterns of uterine contractions via the telephone, which are then interpreted by nursing specialists available 24 hours a day. It is thought that such a program can reveal information earlier than programs relying on patient-perceived signs and symptoms of labor. The added value of monitoring uterine activity over seven patient-reported symptoms was studied among 120 women at risk for preterm delivery. Of the 42 patients experiencing preterm labor, uterine activity alone (without patient-reported symptoms) caused 13 patients (31 percent) to make an unscheduled visit to the physician, while patient-perceived signs and symptoms alone (without increased uterine activity) initiated 10 unscheduled visits (24 percent). It is concluded that daily assessments of uterine activity measured by a tocodynamometer contributed more information leading to a diagnosis of preterm labor than patient-perceived signs and symptoms alone. (Consumer Summary produced by Reliance Medical Information, Inc.)
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