Home preterm labour care is a viable alternative to hospital care for women without complications

Büscher, Dr Ulrich

Senior Registrar, Department of Obstetrics, Charité Campus Virchow-Klinikum, Humboldt-University, Berlin

Abstracted from:Goulet C, Gevry H, Lemay M, Gauthier RJ, Lepage L, Fraser W, Polomeno VA. Randomised clinical trial of care for women with preterm labour: home management vs hospital management. Can Med Assoc J 2001; 164(7): 985-991 .

Evidence-based Healthcare 5(4):p 125-126, December 2001.

BACKGROUND

Early hospital release and home care management strategies have potential psychological and cost advantages over hospital-based care for women experiencing preterm labour. Further assessment is required.

OBJECTIVE

To compare the neonatal and maternal outcomes of early hospital release home care with hospital care management strategies for women experiencing preterm labour.

SETTING

Two regional perinatal centres; Montreal and Quebec City; timeframe not specified.

METHOD

Randomised clinical trial.

LITERATURE REVIEW

No explicit strategy; 31 references.

PARTICIPANTS

Two hundred and fifty women experiencing their first episode of preterm labour living within 50 km of the hospital; gestational age of 20 to 35 weeks. Women with two or more pregnancy complications; cervical dilation more than 4 cm and effacement more than 80%; suspicion of fetal malformation or diagnosis of intrauterine death were excluded.

INTERVENTION

Early discharge and home care or in-hospital care. Registered nurses visited and monitored home care participants. Women in the control group received usual individualised in-hospital care.

OUTCOMES

Gestational age at delivery; birth weight; rate of preterm birth; duration of neonatal and maternal hospital stays; number of admissions to a hospital neonatal intensive care unit; and maternal hospital admissions.

MAIN RESULTS

No significant differences were observed between groups for gestational age at delivery (mean 37.5 weeks); mean birth weight (2973 g for home care and 3020 g for hospital care; P = 0.6); neonatal intensive care admissions; intermediate care admissions; or the proportion of births with gestational age >37 weeks. The hospital care group had longer mean duration of hospital neonatal stays (3.8 days for home care versus 6.1 days for hospital care; P = 0.0001) and hospital maternal stays (3.7 days for home care versus 5 days for hospital care; P = 0.03).

AUTHORS' CONCLUSIONS

Early release and home care preterm labour management is a viable alternative to hospital care for women without complications requiring intensive medical care and monitoring.