***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We assessed the effectiveness of the home-visiting system in reducing the care provided in maternity units , especially hospitalization , and attempted to establish whether this system increases  women 's satisfaction with medical care . The trial involved 158 women and was conducted in four maternity units in Paris . A policy of one or two weekly visits by domiciliary midwives was compared with the usual policy of the hospitals . The study was restricted to women with moderate threatened preterm labor between 26 and 36 weeks of gestation . No decrease in the number of women hospitalized or the number of days spent in hospital was observed in the intervention group , but the number of prenatal visits to outpatient clinics was significantly smaller in the intervention than control group . Satisfaction with medical care during the episode of threatened preterm labor was much greater in the intervention group . Home visits by a midwife were considered by the women to be a better care system than numerous outpatient visits or hospitalization . Our results for medical care suggest that the introduction of the home-visiting system did not greatly alter medical practice in the maternity units , although this system had been design ed to avoid or reduce hospitalization The relative contribution of uterine activity obtained by home monitoring with a guard ring tocodynamometer compared with seven specific signs and symptoms reported during patient/nurse contact as an aid in detecting preterm labor has not been studied . In this prospect i ve , multicenter study , patients at risk for developing early labor who were r and omized to receive home uterine activity monitoring and perinatal nursing support  were assessed . The initiator of provider contact ( uterine activity detected on routine transmission , patient-perceived signs and symptoms of preterm labor during perinatal nurse contact , or both ) result ing in a diagnosis of preterm labor was recorded . Contraction data were then analyzed for an association with preterm labor . There was a strong association of increased uterine activity ( four or more contractions per hour ) on a repeat monitoring strip with preterm labor ( P<.001 ) . Among patients diagnosed with preterm labor , 31 % had increased uterine activity detected on a routine transmission without patient reported signs and symptoms , compared with 24 % who were diagnosed as the result of patient-reported symptoms without increased uterine activity . Daily objective uterine activity data alone have greater incremental value over and above other signs and symptoms as an aid to the physician in diagnosing preterm We conducted a health technology assessment of the care of women with high-risk pregnancies in the South Wales valleys . Women in the control arm were intended to receive conventional care with st and ard midwifery visits . Women in the intervention arm received additional or longer visits and domiciliary fetal heart rate telemonitoring .  Eighty-one mothers were r and omized . There were significant differences in midwifery intervention re sources between domiciliary and control groups , with the former receiving a mean of 3.7 visits lasting 33.5 min , compared with 1.4 visits lasting 12.8 min for the latter . There were slightly more spontaneous labours and fewer Caesarean sections in the domiciliary group . Maternal satisfaction and anxiety were high in both groups . Domiciliary care increased the service costs by 21.02 per woman in terms of extra midwife travel and visiting time , and by a further £ 18.38 per woman in home monitoring equipment costs . This , however , was more than offset by health service savings from fewer clinic visits ( £ 35.60 ) and fewer clinic ultrasound scans ( £ 9.01 ) . Adding the reductions in lost productivity to women and their partners ( £ 34.51 ) suggests that domiciliary care was cheaper than conventional care , even if it did not greatly reduce inpatient days ( a reduction nonetheless saving £ 184.24 ) . While clinical processes were similar in both groups , there were useful practical advantages and savings for patients and the health service from the domiciliary intervention BACKGROUND The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in r and omized trials . Nonetheless , ambulatory monitoring of contractions continues to be used in clinical practice . METHODS We assessed the frequency of uterine contractions as a predictor of the risk of  spontaneous preterm delivery before 35 weeks of gestation . We enrolled women with singleton pregnancies between 22 and 24 weeks of gestation . The women used a contraction monitor at home to record contraction frequency twice daily on 2 or more days per week from enrollment to delivery or 37 weeks of gestation . RESULTS We obtained 34,908 hours of successful monitoring recordings from 306 women . Although more contractions were recorded from women who delivered before 35 weeks than from women who delivered at 35 weeks or later , we could identify no threshold frequency that effectively identified women who delivered preterm infants . The sensitivity and positive predictive value of a maximal hourly frequency of contractions of four or more between 4 p.m. and 3:59 a.m. were 9 percent and 25 percent , respectively , at 22 to 24 weeks and 28 percent and 23 percent at 27 to 28 weeks . Other proposed screening tests , such as digital and ultrasound evaluations of the cervix and assays for fetal fibronectin in cervicovaginal secretions , also had low sensitivity and positive predictive value for preterm labor . CONCLUSIONS Although the likelihood of preterm delivery increases with an increased frequency of uterine contractions , measurement of this frequency is not clinical ly useful for predicting preterm delivery In this investigation , 45 women with twin gestations in four centers were r and omly assigned to either daily home uterine activity monitoring and perinatal nursing support ( 19 ) or an education group ( 26 ) . Patients in the home uterine activity monitoring and perinatal nursing support group monitored uterine activity twice daily , transmitted the data each day , and had 24 hour-a-day access to nursing support . Education patients were counseled regarding the common signs and symptoms of preterm labor . Both groups had scheduled prenatal visits at least every 2 weeks . Sixteen ( 62 % ) of the education group and 14 ( 74 % ) of the home uterine activity monitoring and perinatal nursing support group developed preterm labor , values that were not significantly different . Of the monitored group who experienced preterm labor , all 14 were dilated 3 cm or less at diagnosis of the first preterm labor , compared with ten of 16 in the education group ( P= .01 ; one-tailed Fisher test ) . The mean cervical dilatation at the first preterm labor episode in the group receiving daily monitoring and contact ( 1.6 cm ) was significantly less ( P= .01 ) than that in the education group ( 2.9 cm ) . Thus , fewer preterm births were recorded in the home uterine activity monitoring and perinatal nursing support group and significantly fewer patients delivered because of tocolysisfailed(P= .03 BACKGROUND Preterm labour occurs in about 10 % of all pregnancies and is the most important cause of premature birth . Women with preterm labour are admitted to hospital to have the contractions stopped . Thereafter , many women remain in hospital until delivery . We conducted a r and omized clinical trial to compare hospital care with home care of women who had been admitted to hospital for preterm labour . METHODS After they had received treatment for an acute episode of premature labour , women at 2 regional perinatal centres associated with teaching hospitals were r and omly assigned to home care or hospital care .  Eligible women ( n = 250 ) were aged 18 years or older , lived within 50 km of the hospital , had a gestational age between 20 and 35 weeks , had no prior preterm delivery and were experiencing their first episode of preterm labour and first admission to hospital for preterm labour . Analysis was by intention to treat . RESULTS There were no significant differences between the 2 groups in mean gestational age at delivery ( home : 37.52 weeks , hospital : 37.50 weeks ) or in mean birth weight ( home : 2974 g , hospital : 3020 g ) . There were no significant differences between the 2 groups with respect to the proportions of babies born before term or the mean duration of neonatal hospital stay , neonatal intensive care unit stay and intermediate care nursery stay . The mean duration of the first stay in hospital for the women in the home group ( 3.8 days ) was significantly shorter than the mean duration for women in the hospital group ( 6.1 days ) . In addition , the mean duration of all maternal stays in hospital was significantly shorter for the women in the home group ( 3.7 days ) than in the hospital group ( 5.0 days ) . INTERPRETATION Home care management is an efficient and acceptable alternative to hospital care for women experiencing preterm labour In a prospect i ve trial we enrolled 157 women at increased risk of preterm birth , r and omly assigning women in a ratio of 1:2 to receive either frequent ( greater than or equal to 5 days/wk ) nursing contact , education in preterm labor symptoms , and self-palpation of uterine activity ( group E , n = 50 ) , or daily nursing contact , preterm labor education , and the Term Guard home uterine activity monitor ( group EM , n = 107 ) . Comparison of the rate of preterm birth , the incidence of preterm labor and successful tocolysis , and the mean birth weight and gestational age revealed no significant differences and suggested that beneficial effects previously attributed to monitored contraction data may in fact be the result of frequent ( five or more times per week ) nursing contact and careful attention to preterm labor symptoms and perceived contractions Home uterine activity monitoring has been described as an effective means of detecting uterine contractions , but controversy exists whether it is home uterine activity monitoring or increased nursing support in conjunction with it that contributes to earlier detection of preterm labor . In this study 377 women at risk for preterm labor from three centers were prospect ively , r and omly assigned to  high-risk prenatal care alone ( not monitored ) or to the same care with twice-daily home uterine activity monitoring without increased nursing support ( monitored ) . The two groups were medically and demographically similar at entry into the study . Routine visits , nonroutine visits , and gestational age at diagnosis of preterm labor were similar in both groups . Preterm labor occurred in 41 of 198 monitored and 39 of 179 not monitored patients .  Mean cervical dilatation was 1.4 cm in 41 monitored compared with 2.5 cm for 37 not monitored ( p = 0.0006 ) ; 73.1 % of monitored and 27.5 % of not monitored had preterm labor detected before 2 cm dilatation ( p = 0.00009 ) . Neonatal outcome of singleton pregnancies showed greater birth weight , fewer days in the neonatal intensive care unit , and fewer babies requiring oxygen therapy and mechanical ventilation in the monitored group . The better outcomes are probably due to the increased likelihood of diagnosis of preterm labor before advanced cervical dilatation with home uterine activity monitoring , thus providing the clinician with a better chance to initiate tocolytic therapy directed at improving pregnancy outcome OBJECTIVE To compare safety and cost-effectiveness of domiciliary antenatal fetal monitoring ( cardiotocography and obstetric surveillance ) with in-hospital monitoring in high-risk pregnancies . METHODS From September 1992 to June 1994 , 150 consecutive women with high-risk pregnancies , who would otherwise be monitored in the hospital , entered a r and omized controlled trial of in-hospital ( n = 74 ) or domiciliary ( n = 76 ) monitoring . The main outcome measures were neonatal safety ( Prechtl neurologic optimality score , the proportion of non-optimals ) and cost-effectiveness . To test a two-point difference in mean Prechtl scores ( two-tailed o = .05 . 1-beta = .80 ) , 150 women were needed .  Safety and cost-effectiveness were analyzed according to intention to treat . Conditional on the safety outcomes , a cost-minimization analysis based on actual re source use was performed . Uncertainty of results was explored by sensitivity analyses . RESULTS Neonatal outcomes were equal . No cost-shifting between the antenatal and postpartum period occurred . Substituting domiciliary for in-hospital monitoring reduced mean ( st and ard deviation ) antenatal costs from $ 3558 ( $ 2841 ) to $ 1521 ( $ 1459 ) per woman ( P < .001 ) . If costs were varied by the addition of 50 % , costs were still reduced . The magnitude of the reduction was sensitive to the costs of hospital care and less sensitive to the costs of domiciliary monitoring . CONCLUSION Domiciliary monitoring is safe and reduces costs by one-half . The technique seems transferable to other setting s but local circumstances may sometimes hamper its dissemination OBJECTIVE Is domiciliary antenatal fetal surveillance for selected high risk pregnancies , a feasible alternative for hospital admission ? DESIGN A r and omized controlled trial conducted at the Academical Medical Centre , Amsterdam , The Netherl and s. SUBJECTS Between September 1992 and June 1994 , 76 women were at r and om 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 . CONCLUS 
    Output:
    
Important group differences were not evident when we undertook sensitivity analysis using only trials at low risk of bias .
There is no impact on maternal and perinatal outcomes such as perinatal mortality or incidence of preterm birth