The contribution of symptomatology and/or uterine activity to the incidence of unscheduled visits

Article Abstract:

Preterm birth, the delivery of a fetus before the 37th completed week of pregnancy, often results in a poor pregnancy outcome. The earlier preterm labor is diagnosed, the more effective long-term prevention measures will be. For this reason, preterm prevention programs are designed to identify women at risk for early labor and diagnose and preterm labor as early as possible. Preterm labor is marked by changes in the cervix (dilation and thinning) and regular uterine contractions. Women attending a standard preterm prevention program are taught the signs and symptoms of labor. A new program utilizes a home monitoring system known as a tocodynamometer, which measures, records and transmits uterine contraction patterns via the telephone to perinatal nurses who are available 24 hours a day. The nurses are able to then assess the signs and symptoms of preterm labor. It is not known whether the addition of home monitoring prevention approaches will result in more unscheduled emergency visits. The frequency of unscheduled visits was compared between 163 women receiving the standard teaching protocol (patient-reported symptoms) and 151 women using the home monitoring system combined with 24-hour nursing support. The number of unscheduled visits was similar in both groups: 221 in the monitored group (average of 1.5 visits per patient) versus 170 in the educated group (average of 1.3 visits per patient). The number of monitored women diagnosed with preterm labor during unscheduled visits was 89 (40 percent), compared with 90 diagnoses (53 percent) in the group receiving education alone. Of the visits resulting in a diagnosis of preterm labor, 32 (36 percent) were precipitated by monitored uterine activity alone and 32 (36 percent) were prompted by patient-perceived signs and symptoms. Preterm labor was not diagnosed during an unscheduled visit (false-positive visit) in 25 percent of the monitored women and 45 percent of the women relying on signs and symptoms alone. Most of the false-positive results were in the group relying on signs and symptoms alone. Home monitoring combined with daily nursing support does not substantially increase the number of unscheduled visits (one such visit for the entire pregnancy for every two patients). Home monitoring of uterine contractions in conjunction with perinatal nursing support has a high degree of sensitivity (93 percent) in detecting preterm labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Management of preterm labor patients at home: does daily uterine activity monitoring and nursing support make an difference?

Article Abstract:

Preterm birth, delivery of a fetus before the 37th completed week of pregnancy, is associated with a poor pregnancy outcome. To help reduce the preterm delivery rate, prevention programs are designed to diagnose preterm labor as early as possible. The earlier preterm labor is diagnosed, the more likely pregnancy can be prolonged by means of strategies to arrest labor. When labor has been arrested in the hospital with rest, fluid therapy and tocolytic drug therapy, the patients are often sent home. However, patients treated for early labor will often develop early labor again. Standard prevention programs involve teaching women at risk for an early delivery the signs and symptoms of labor. Relying on patient-perceived symptoms is not always effective in detecting recurrent preterm labor. A home monitoring system known as an ambulatory tocodynamometer was developed which measures, records and transmits patterns of uterine contractions via the telephone to perinatal nurses, who are available 24 hours a day. The nurses received the monitored transmissions twice a day and assessed signs and symptoms of preterm labor. To see if a program of home uterine monitoring combined with daily nursing support was useful in managing recurrent preterm labor, 67 women successfully treated for a prior episode of labor were studied. Preterm labor, defined as regular contractions for more than one hour accompanied by changes in the cervix, were experienced by 15 women (45 percent) in the home monitored group and 19 women (56 percent) receiving the standard education relying on signs and symptoms alone. Early delivery was experienced by seven patients (47 percent) in the monitored group compared with 16 (84 percent) in the group receiving the standard care. More of the patients relying on signs and symptoms alone delivered after recurrent labor failed to respond to drug therapy. None of the monitored patients delivered after recurrent labor management failed. Therefore, tocolytic therapy (drugs that arrest labor) was more effective in preventing delivery when given to patients who were being monitored and receiving nursing support than when given to patients receiving only standard care. Home monitoring and daily nursing support was useful in preventing preterm delivery by detecting labor early and prolonging pregnancy in patients with recurrent preterm labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Premature birth

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