Clinical review of home uterine activity monitoring (HUAM)
MARK A. KALCHBRENNER, DO
Preterm birth is associated with significant neonatal mortality and morbidity nationwide.
Multiple strategies have been used to attempt to reduce the incidence of preterm births, and none have been entirely successful. The current review contains assessment of recent literature and home uterine activity monitoring. It also makes some suggestions about how and when this diagnostic modality may be used in current obstetric practice.
(Key words: home uterine activity monitoring, preterm birth, pregnancy)
It has long been recognized that pretermirth occurring before 37 weeks has been a significant factor in perinatal mortality and morbidity.1-3 Despite a decline in neonatal mortality during the past 20 years, preterm birth affects more than 350,000 babies each year in the United States, and these births contribute to approximately 85% of all neonatal deaths.2,4-7 Low-birthweight babies account for 60% of all infant mortality, even though they account for less than 7% of the total births. In spite of
spending more money on healthcare than any other nation, the United States ranks below 22 other industrialized countries in the rate of infant mortality. Every lowbirth- weight infant ( 2500 g) costs the United States healthcare system approximately $14,000 to $30,000.8 For verylow- birth-weight infants ( 1500 g), these costs can approach millions. Neonatal intensive care costs in the United States
alone exceed $5 billion yearly.9 Despite many advancements in perinatal care, the incidence of preterm labor and subsequent early or low-birth-weight delivery has essentially remained unchanged.4 Reliable and accurate screening systems for the prediction of premature birth
have so far been elusive. Consequently, attention has been focused on the detection and management of preterm labor, which can lead to preterm birth. Thus, much effort has been put forth to accurately
detect and effectively manage the occurrence of preterm labor. The effects of tocolytic and other therapy in arresting preterm labor and preventing preterm birth have been limited, because up to 80% of patients in whom preterm labor develops do not seek medical attention until they have ruptured
membranes or advanced cervical dilation or both. Successful tocolysis is unlikely after advanced cervical dilation or effacement. 10-12 For these reasons, the importance of early detection of less-advanced preterm labor has been emphasized.
The early detection of preterm labor has been the focus of a number of preterm birth prevention programs that incorporate the identification of patients at high risk, patient education, self-palpation for uterine contractions, and frequent cervical examinations.13 Several studies have found this approach to be successful in increasing the proportion of patients with preterm labor who seek care while they are still favorable for tocolytic suppression. 13-16 These programs, however, have not been uniformly successful.17,18 Contributing to the failure of some of these programs is the fact that uterine activity associated with preterm labor often is not accurately perceived by the patient.19-21
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