High risk pregnancy monitored antenatally at home

Abstract

Objective: Is domiciliary antenatal fetal surveillance for selected high risk pregnancies, a feasible alternative for hospital admission?

Design: A randomized controlled trial conducted at the Academical Medical Centre, Amsterdam, The Netherlands.

Subjects: Between September 1992 and June 1994, 76 women were at random allocated to domiciliary care and 74 women to hospital care. Criteria for inclusion were hypertension (26%), fetal growth retardation (24%), post term pregnancy (23%), diabetes (24%), preterm rupture of membranes (2%) and previous recurrent antenatal death (1%).

Main outcome measures: Primary outcome measure was perinatal morbidity, measured by Prechtl's neonatal neurological optimality score. Secondary outcome variables were the occurrence of complications, obstetric interventions at labour, birthweight, gestational age at delivery and maternal and neonatal admission rates.

Results: In both groups there was one case of perinatal mortality. In both treatment groups the median of the neurological optimality score was found at 59. Also secondary outcome variables did not show significant differences.

Conclusion: Domiciliary antenatal care for selected women with high risk pregnancy is feasible considering obstetric outcome.