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Predicting Pre-term Labor?

Gauging Effectiveness of Home Uterine
Activity Monitors
By Teri Brown

The concept is brilliantly simple. Devise a method of predicting pre-term labor in high-risk pregnancies so there's a greater chance the labor can be postponed, allowing the mother to carry the baby as close to term as possible. Design the method to be home-based, so the mother can rest in her own surroundings rather than exposing herself and her family to the stress and cost of a long hospital stay. Such a devise could change the face of high-risk pregnancies. But wait – we have such a method. Or do we?

Who would have thought a device designed to catch pre-term labor in high-risk pregnancies would have generated such controversy? But the Home Uterine Activity Monitor (HUAM) system has done just that.

An Informed Choice
Some women swear by them, while others are concerned the monitors give mothers a false sense of security and make them miss other signs that pre-term labor is imminent. The studies done on the HUAM don't show they are definitely effective in preventing pre-term delivery. Supporters of the HUAM charge the studies are flawed, having been conducted with mostly singleton pregnancies rather than higher order (triplets or more) pregnancies. So how is a mother to make an informed choice with all the conflicting data, opinions and controversy?

Common sense tells us that the HUAM should be effective. The monitor, which is actually a transducer, is strapped around the waist with a belt for one hour twice a day. It is designed to pick up contractions the pregnant woman may not even realize she is having. The device relays information through the phone line to nurses at a central monitoring office who then contact the patient's physician if there is a problem.

Kathleen Osborn, a perinatal nurse coordinator for St. Louis, Mo.-based Biomedical Systems, works in one such central monitoring office. There is no question in her mind that, when used with a complete home monitoring program including education and twice-daily phone conversations with trained nurses, the HUAMs are effective in helping to detect pre-term labor in its early stages.

"It catches the contractions that the patients don't feel," says Osborn. "I think it's a very a useful tool for moms at high risk of pre-term labor. We have caught moms who were entering labor early, and the labor was postponed."

The Biomedical Systems monitoring program detects and documents patients' uterine activity. Experienced obstetrical nurses review uterine contraction activity and conduct maternal and fetal assessments. Because it's done through the telephone, Biomedical Systems can monitor women in remote areas. If you're several hours from a hospital, this may be your best chance of detecting problems early.

Whether their success in detecting pre-term labor is because of the monitors or talking to the patients every day is debatable, but Osborn isn't sure that's the point. "The goal is in detecting the pre-term labor," says Osborn. "Sometimes we can pick up something in our conversations with the patient, something they may think is no big deal."

Putting together those conversations along with the data from the HUAM can alert the nurses who in turn alert a patient’s doctor.

Peace of Mind
For Debbie Craig of Manassas, Va., using the monitor gave her a peace of mind she wouldn't have had otherwise. After going into pre-term labor at 27 weeks, she used a HUAM for the rest of her pregnancy.

"I believe the use of the HUAM predicted when I needed to get to a doctor or hospital for care to stop pre-term labor," says Craig. For Craig, her ability to stay home made all the difference in an already high-stress situation.

"Long hospital stays are depressing, and I was more comfortable and able to relax at home," says Craig, who delivered a healthy baby at 35 1/2 weeks. "Because of the HUAM and the 24-hour nursing staff available to me in conjunction with it, my doctors allowed me to stay at home. I had several hospital visits and overnight stays during my bed rest, but if it were not for my monitor, I would have remained in the hospital for the duration of the pregnancy."

Amy Ciessau of Glendale, Ariz., would unreservedly recommend the HUAM to other mothers with high-risk pregnancies. "As a high-risk bedridden Mom, I was scared for my babies. I am also one who hates calling doctors because I always felt like I was ‘bothering’ them, especially after hours," says Ciessau. "Having the nurses available 24 hours a day and knowing if I felt like something was wrong, all I had to do was monitor was constant reassurance.”

For Ciessau, it was the combination of actual monitoring and interaction with a medical professional that makes HUAM so valuable.

That is exactly what concerns Dr. Carey Winkler, an OB/GYN and perinatologist with Oregon Health and Science University Hospital in Portland, Ore. "I think that, too often, the monitors can actually increase a woman's anxiety," says Dr. Winkler. "There are far better indications of pre-term labor than the HUAMs."

Cause for Concern
Dr. Winkler believes the Transvaginal Ultrasound is a more consistent predictor than contractions at predicting pre-term labor, as is the Fetal Fibro Nectin (FFN) test. "If a woman comes in with pre-term contractions and we find by the Transvaginal Ultrasound that her cervix is normal and the FFN is negative, there is a less than 1 percent chance that she's going into pre-term labor," says Dr. Winkler. "We don't have to send her home to wait on pins and needles for the next monitoring session."

One study led by researchers from Ohio State University suggests that HUAMs have no value in actually predicting early delivery. This study was published in the January 2002 New England Journal of Medicine.

There is added emphasis on the system’s usefulness because of the cost of HUAMs, which can be as high as $100 a day. But Osborn, the perinatal nurse coordinator, believes the HUAMs method and the nursing support that goes with it is very cost effective, especially when compared to the cost of one day in the hospital or the even higher cost of the Neonatal Intensive Care Unit.

"I think we figured once that one day in the NICU would cover 41 days of using an HUAM with 24-hour support," says Osborn.

To the mother experiencing a high-risk pregnancy, there are no easy answers. Clearly, education is needed to make an informed decision, but in the end, it may just come down to personal choice. Would you rest easier with an HUAM system in place? Or would that merely create more anxiety? At any rate, HUAMs are here to stay, whether or not the controversy surrounding them subsides.

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About the Author: Teri Brown is an Oregon-based freelance writer for iParenting Media and the mother of two.

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