Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, blinding and incomplete outcome data in half of the trials).
A Cochrane review included 15 studies with a total of 6008 subjects. Women at high risk of preterm birth were randomly assigned to home uterine monitoring (one- to two-hour periods each day) or conventional care. Monitoring results were transmitted daily by modem to a base centre for interpretation by a midwife or doctor. There was no significant difference in the rate of perinatal mortality (RR 1.22, 95% CI 0.86 to 1.72; 2 studies, n=2589) between the home monitoring group vs conventional care group. Women using home uterine monitoring were less likely to experience preterm birth at less than 34 weeks (RR 0.78, 95% CI 0.62 to 0.99; 3 studies, n=1596). However, this difference was not evident when restricting the analysis to studies at low risk of bias based on study quality (RR 0.75, 95% CI 0.57 to 1.00; 1 study, n=1292 women). There was no significant difference in the number of preterm births at less than 37 weeks (average RR 0.85, CI 0.72 to 1.01; 8 studies, n=4834; I² 68%). Infants born to women using home uterine monitoring were less likely to be admitted to neonatal intensive care unit (average RR 0.77, 95% CI 0.62 to 0.96; 5 studies, n=2367; I² 32%). However, this difference was not statistically significant when only high quality studies were included (RR 0.86, 95% CI 0.74 to 1.01; 1 study, n=1292). Women using home uterine monitoring made more unscheduled antenatal visits (mean difference (MD) 0.49, 95% CI 0.39 to 0.62; 2 studies, n=2807) and were more likely to have prophylactic tocolytic drug therapy (average RR 1.21, 95% CI 1.01 to 1.45; 7 studies, n=4316; I² 62%) but this difference was no longer significant when the analysis was restricted to high quality studies (average RR 1.22; 95% CI 0.90 to 1.65, 3 studies, n=3749, I² 76%).