Daily self-monitoring fetal assessment and transmission from home in fetal growth restriction pregnancies

FROM HOME IN FETAL GROWTH RESTRICTION PREGNANCIES MOSHE HOD, ELINA BELKIN, RAM KERNER, RONY CHEN, AVI BEN-HAROUSH, YARIV YOGEV, DOV FELDBERG, Rabin Medical Center, Perinatal Division, Department of Obstetrics and Gynecology, Petach-Tikva, Israel OBJECTIVE: Lack of evidence exists if the frequency of antenatal surveillance for fetuses with suspected fetal growth restriction (FGR) alters perinatal outcome.We sought to compare daily home self-monitoring to routine antenatal ambulatory assessment. STUDY DESIGN: 19 gravid patients with diagnosed FGR (sonographic estimated fetal weight < 10th percentile) transmitted daily self-performed NST to a perinatal center (MFM specialists consultation) and were match controlled in a 2.5:1 ratio to 48 gravid patients with FGR followed by the same physicians on a once weekly basis, antenatal assessment in the clinic. At each transmission, patients were asked about perceived fetal movements and uterine contractions. If the tracing was non-reassuring, patients were invited to the hospital for further antenatal evaluation. Pregnancy outcome was compared in the two groups. RESULTS: (1) Maternal age (28.1 ± 5 vs 29 ± 5, P = .5), gestational age at enrollment (32.3 ± 2.2 vs 32 ± 2, P = .63), and nulliparity rate (42% vs 41%, P = .86) were comparable between the groups. (2) Gestational age at delivery was significantly higher in the study group (36.4 ± 1.9 vs 34.3 ± 3.1, P = 0.03). (3) Overall, 348 NSTs were performed in the study group. In 7 of 19 patients an immediate need for intervention was identified, and in 4 patients emergency cesarean section (CS) was performed. In the control group 2 of 48 NSTs during antenatal visit were followed by immediate intervention. (4) CS rate and NICU admission rate were similar in both groups (63% vs 73%, P = .5 and 37% vs 54%, P = .17, respectively). Birth weight was significantly higher in the study group (2121 ± 585 vs 1783 ± 699 grams, P = 0.02). CONCLUSION: Data suggest that a prolongation of pregnancy can be achieved in FGR pregnancies by daily fetal assessment with no immediate neonatal adverse outcomes. We speculate this may have a potential costeffectiveness benefit.