A Randomized Clinical Trial of Care for Women With Preterm Labour: Home Management Versus Hospital Management

Goulet, Céline; Gévry, Hélène; Lemay, Michel; Gauthier, Robert; Lepage, Linda; Fraser, William D.; Polomeno, Viola

doi:10.1097/00006254-200111000-00004

Cited by 12 publications

(21 citation statements)

References 14 publications

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“…Our results are in line with previous studies done before the widespread use of ultrasound in which long-term hospitalization (between 6 and 16 days) was demonstrated to be of no use in prolonging pregnancy compared to outpatient management [25,26]. Moreover, they are consistent with other nonrandomized reports in which clinical protocols incorporating ultrasound assessment of CL were shown to be useful in avoiding unnecessary prolonged hospitalization and in reducing the mean hospital stay by about 2 days [17,18,20].…”

Section: Discussionsupporting

confidence: 92%

“…The study was designed in the late nineties, well before the extended use of CL in clinical practice. However, although the information obtained in this study may seem to be outdated, there are few studies on women hospitalized because of threatened preterm labor [5,17,18,25,26]. Moreover, recent studies using CL in patients admitted because of threatened preterm labor have shown that the mean CL at admission is comparable with ours and that up to 70-85% of patients admitted will finally deliver at term [4,5,9,13,14].…”

Section: Discussionsupporting

confidence: 45%

“…This might be due to the fact that most studies in this review evaluated CL before decision of admission and not after tocolysis when the patient was stable; therefore, our study adds information regarding women already admitted. The high consistency (I 2 = 0.0%) of the pooled negative likelihood ratio for CL <25 mm reported by Sotiriadis et al allows clinicians to safely follow symptomatic patients in outpatient conditions [26].…”

Section: Discussionmentioning

confidence: 77%

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Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

et al. 2017

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Objective: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor. Methods: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24⁺⁰ and 35⁺⁶ weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status. CL measurement was performed 24-48 h after admission. In the control group, the patient and the physician in charge were blinded. In the study group, this information was given; if CL was >25 mm, early discharge within 12-24 h from randomization was recommended. Length of hospital stay was the main outcome. Results: After randomization, 149 patients had complete follow-up (control group, n = 74; study group, n = 75). The mean (SD) length of stay was significantly shorter - 3.0 (2.2) vs. 4.0 (2.0) days (p = 0.004) - in the study group, with a higher proportion of women remaining hospitalized ≤3 days (relative risk [95% confidence interval] 0.43 [0.26-0.70]), with no differences in GA at delivery or preterm birth rate. Conclusions: Knowledge of CL in women admitted because of threatened preterm labor is useful in reducing length of stay, with no impact on GA at delivery or preterm birth rate.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 45%

Section: Discussionmentioning

confidence: 77%

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Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

et al. 2017

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“…Other studies have shown the ineffectiveness of prolonged prophylactic hospitalization in the management of twin gestations prior to the onset of complications. 22,23,24 In summary, the current study reveals that SQT usage in the home for patients at risk for early delivery offers a significant advantage when compared to prolonged hospitalization for tocolytic therapy. Because of the increased gestational age at delivery and fewer low birth weight infants, there were significantly lower costs associated with the care of these women compared to those managed in the hospital.…”

Section: Significancementioning

confidence: 77%

Clinical and Economic Outcomes of Preterm Labor Management: Inpatient vs Outpatient

Ambrose

Rhea²,

Istwan³

et al. 2004

J Perinatol

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OBJECTIVE:To compare pregnancy and economic outcomes in women receiving inpatient vs outpatient tocolysis with continuous subcutaneous terbutaline (SQT). STUDY DESIGN:Identified within a database were women prescribed SQT at 24.0 to 33.9 weeks' gestation following stabilization of an acute episode of preterm labor. Women with cervical dilatation >3 cm, and/or maternal or fetal instability were excluded. Those with prolonged inpatient care were matched 1:1 to those discharged with outpatient follow-up by cervical dilatation, gestational age, and fetal number yielding 90 matched pairs (180 women). RESULTS:Inpatients had an earlier gestational age at delivery (34.1±2.9 vs 35.8±1.9 weeks, p<0.001), higher preterm birth rate (86.7% vs 74.4%, p ¼ 0.043) and higher overall costs ($56,089±$47,944 vs $25,540±$25,847, p<0.001) than outpatients. CONCLUSION:Outpatient management resulted in improved pregnancy outcomes at a cost less than that of inpatient management in this analysis of women treated with SQT.

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“…This review of home visits included ten RCTs (n = 9274 women); [479][480][481][482][483][484][485][486][487][488] two RCTs were added to the primary studies identified in an earlier review. 489 Further details of the review and the two additional RCTs can be found in Appendix 6, Table 126.…”

Section: Home Visitsmentioning

confidence: 99%

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

2010

Clinical Governance: An International Journal

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A Randomized Clinical Trial of Care for Women With Preterm Labour: Home Management Versus Hospital Management

Abstract: This article has been peer reviewed.

Cited by 12 publications

References 14 publications

Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

Uterine Cervical Length Measurement to Reduce Length of Stay in Patients Admitted for Threatened Preterm Labor: A Randomized Trial

Clinical and Economic Outcomes of Preterm Labor Management: Inpatient vs Outpatient

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

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