Home labour induction with retrievable prostaglandin pessary and continuous telemetric trans-abdominal fetal ECG monitoring

Abstract

Objective: To evaluate the feasibility of continuous telemetric trans-abdominal fetal electrocardiogram (a-fECG) in women undergoing labour induction at home.

Study design: Low risk women with singleton term pregnancy undergoing labour induction with retrievable, slow-release dinoprostone pessaries (n = 70) were allowed home for up to 24 hours, while a-fECG and uterine activity were monitored in hospital via wireless technology. Semi-structured diaries were analysed using a combined descriptive and interpretive approach.

Results: 62/70 women (89%) had successful home monitoring; 8 women (11%) were recalled because of signal loss. Home monitoring lasted between 2-22 hours (median 10 hours). Good quality signal was achieved most of the time (86%, SD 10%). 3 women were recalled back to hospital for suspicious a-fECG. In 2 cases suspicious a-fECG persisted, requiring Caesarean section after recall to hospital. 48/51 women who returned the diary coped well (94%); 46/51 were satisfied with home monitoring (90%).

Conclusions: Continuous telemetric trans-abdominal fetal ECG monitoring of ambulatory women undergoing labour induction is feasible and acceptable to women.

Figure 1. Fetal ECG monitoring device (MONICA AN24).

Copyright and courtesy of Monica healthcare limited. Portable trans-abdominal fetal ECG monitoring device with 5 electrodes attached to the maternal abdomen.

Figure 2. Monitoring display.

Continuous monitoring display from the MONICA AN24 device of fetal and maternal heart rate, uterine contractions and maternal movements. (Fetal heart rate – black line (top); maternal heart rate – green line (middle); Uterine contractions – black line (bottom); maternal movements – orange bars).