What is HUAM?

Home uterine activity monitoring (HUAM) involves the

collection of data on uterine contractions using a tocodynamometer.
The home tocodynamometer consists of a pressure sensor held
against the abdomen by a belt and a recording/storage device that is
carried by a belt or hung from the shoulder. Uterine activity is typically
recorded by the patient for one hour, twice daily, while performing
routine activities. The stored data are transmitted via telephone to a
practitioner, where a receiving device prints out data. Patients are
often contacted by, or have access to, personnel who can address
monitoring problems.
http://canadiantaskforce.ca/wp-
content/uploads/2013/03/Chapter14_uterine_act_monitor94.pdf?414ed1
The Use of Home Uterine Activity Monitoring to Prevent Preterm
Birth ; Geoffrey Anderson, 2013


HUAM may be considered medically necessary on an individual case exception basis for women who can not feel
their contractions and have any of the following complications:
Incompetent cervix (as documented by need for cerclage or signs of cervical incompetence
(funneling on valsalva, silent shortening); or
Presence of risk factors that increase risk of preterm birth: placenta previa with hemorrhage; history
of classical caesarean section or deep myomectomy with contractions/cervical change in index
pregnancy, such that woman is not able to safely tolerate contractions; or
Triplets, quadruplets, or greater multiple gestations (however, HUAM is not considered medically
necessary in twin gestations unless other extenuating circumstances exist); or
Women with preterm labor, where conventional methods to arrest progression of preterm labor
have failed; or
Women with a positive fetal fibronectin test and progressive cervical changes (with cervical length
less than 2.5 cm documented by vaginal probe ultrasound) despite treatment with multiple
tocolytics.

Background
Large randomized controlled trials have demonstrated that the use of a home uterine monitor is not associated with a
decrease in the incidence of preterm birth. This analysis is supported by policy statements by the American College
of Obstetricians and Gynecologists (1997; 2001; 2003) and the U.S. Preventive Services Taskforce (1996). An
evidence report prepared for the Agency for Healthcare Research and Quality (AHRQ) (2000) concluded that "home
uterine activity monitoring was found to confer no maternal or fetal/neonatal benefits".
Reichmann (2008) stated that the current paradigm in obstetrics has shifted toward evidence-based medicine, and
yet in clinical practice physicians continue to use interventions for which there exists no credible evidence. The
author examined the United States Food and Drug Administration (FDA) status of home uterine activity monitoring
(HUAM) and the published clinical trials examining HUAM for the management of current preterm labor. The use of
HUAM was introduced into clinical practice and heavily marketed without benefit of scientific rigor. Gradually, HUAM
use migrated primarily for patients diagnosed (or mis-diagnosed) with preterm labor in the current pregnancy who are
stabilized and sent home with or without a tocolytic. This clinical intervention has not been cleared by the FDA, has
virtually no scientific support, and constitutes a gross deviation from evidence-based medicine. As obstetricians
accept the role of medical evidence steering clinical practice, HUAM clearly has no clinical value and therefore should
not be used to manage patients outside of a randomized controlled clinical trial.
In a Cochrane review, Urquhart et al (2012) examined if HUAM is effective in improving the outcomes for women and
their infants considered to be at high-risk of preterm birth, when compared with conventional or other care packages
that do not include HUAM. These investigators searched the Cochrane Pregnancy and Childbirth Group's Trials
Register (November 30, 2011), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to November
30, 2011), EMBASE (1974 to November 30, 2011), CINAHL (1982 to November 30, 2011) and scanned reference
lists of retrieved studies. Randomized control trials of HUAM, with or without patient education programs, for women
at risk for preterm birth, in comparison to the same care package without HUAM were selected for analysis. Two
review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. Data were
checked for accuracy. These researchers did not attempt to contact authors to resolve queries. There were 15
included studies (total number of enrolled participants 6,008); 13 studies contributed data. Women using HUAM were
less likely to experience preterm birth at less than 34 weeks (risk ratio (RR) 0.78; 95 % confidence interval (CI): 0.62
to 0.99; 3 studies, n = 1,596; fixed-effect analysis). However, this significant difference was not evident when the
authors carried out a sensitivity analysis, 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, 1,292 women). There was no significant difference in the rate of perinatal
mortality (RR 1.22; 95 % CI: 0.86 to 1.72; 2 studies, n = 2,589). 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 = 4,834; random effects, T(2) =
0.03, I(2) = 68 %). Infants born to women using HUAM 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 = 2,367; random-effects, T(2) = 0.02, I(2) = 32 %). Although
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 = 1,292). Women using HUAM made more unscheduled antenatal visits (mean difference (MD) 0.49;
95 % CI: 0.39 to 0.62; 2 studies, n = 2,807). Women using HUAM were also more likely to have prophylactic tocolytic
drug therapy (average RR 1.21; 95 % CI: 1.01 to 1.45; 7 studies, n = 4,316; random-effects. T(2) = 0.03, I(2) = 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 = 3,749,random effects, T(2) = 0.05, I(2) = 76 %). One small study reported
that the HUAM group spent fewer days in hospital antenatally. No data on maternal anxiety or acceptability were
found. The authors concluded that HUAM may result in fewer admissions to a neonatal intensive care unit but more
unscheduled antenatal visits and tocolytic treatment. There is no impact on maternal and perinatal outcomes such as
perinatal mortality or incidence of preterm birth.

http://www.aetna.com/cpb/medical/data/100_199/0127.html


Home uterine activity monitoring: the role of medical evidence
Obstet Gynecol. 2008 Aug;112(2 Pt 1):325-7. doi: 10.1097/AOG.0b013e3181801d66.
As obstetricians accept the role of medical evidence steering clinical practice, HUAM clearly has no clinical value and
therefore should not be used to manage patients outside of a randomized controlled clinical trial.

Risk scoring systems for the prevention of preterm birth
Davey M-A, Watson L, Rayner JA, Rowlands S
Published Online:
November 9, 2011
- See more at: http://summaries.cochrane.org/CD004902/risk-scoring-systems-for-the-prevention-of-preterm-
birth#sthash.M4PtSKB8.dpuf
A number of scoring systems of risk factors associated with preterm birth have been used. Systematic,
objective measures can include age, marital status, socio-economic factors, smoking, threatened miscarriage,
previous low birthweight baby, previous stillbirth, maternal weight and height. Their ability to identify women at
increased risk of preterm birth, and subsequently to prevent preterm birth, has not been evaluated by
randomised controlled trials. The extensive literature search for this review revealed no trials of the use of risk-
scoring systems to prevent preterm birth. There are a number of ethical issues involved in the decision to
implement risk scoring that has not been evaluated; for example, an intervention with potential morbidity and
may be used, or used more frequently with no evidence of more favourable outcomes, or the woman may
prefer not to disclose some sensitive information included in the measures. There is a need for prospective
studies that evaluate the use of risk scoring systems to prevent preterm birth, including an assessment of their
impact on women's well-being. If these prove promising, they should be followed by an adequately powered,
well-designed randomised controlled trial. - See more at: http://summaries.cochrane.org/CD004902/risk-
scoring-systems-for-the-prevention-of-preterm-birth#sthash.M4PtSKB8.dpuf