Abstract
In the complex and often perplexing field of perinatology, it is often tempting to extrapolate the results of the latest published study to our daily clinical practice, especially when the study appears to provide simple answers to difficult questions. This tendency is further encouraged by sensational media coverage and commentaries that, by necessity, further simplify the issues and hype the speculation. Without a critical appraisal of the study population, methodology, analysis and conclusions stated, globalizing a single study's results to anyone's clinical practice can be well-intentioned but misguided. As an example, approximately 1 year ago the results of an NICHD study involving home uterine activity monitoring (HUAM) were released. The study concluded that, while the likelihood of preterm delivery increased with an increased baseline frequency of uterine contractions, measurement of this contractility was not a clinically efficient predictor of preterm delivery. Through the media and editorials that followed, the study results became translated so as to indicate that HUAM was not effective in preventing preterm delivery or improving perinatal outcomes. In our desire for a simple and definitive conclusion on HUAM, key facts about this study were forgotten. In the NICHD study, uterine contraction data were blinded to both physician and patient, and only intermittent preterm monitoring was used with no provision for emergency monitoring; a study design that guaranteed patient management and outcomes would not be affected by HUAM. Using the NICHD HUAM study as an example to be learned from, we should be more critical and independent in our appraisal of published trials. Evidence-based medicine is only useful when we pay as much attention to the methodology as we do to the results.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Katz M, Gill PJ . Initial evaluation of an ambulatory system for home monitoring and transmission of uterine activity data. Obstet Gynecol 1985;66:273–277.
Katz M, Newman RB, Gill PJ . Assessment of uterine activity in ambulatory patients at high risk of preterm labor and delivery. Am J Obstet Gynecol 1986;154:44–47.
Katz M, Gill PJ, Newman RB . Detection of preterm labor by ambulatory monitoring of uterine activity: a preliminary report. Obstet Gynecol 1986;68:773–778.
Newman RB, Gill PJ, Wittreich P, Katz M . Maternal perception of prelabor uterine activity. Obstet Gynecol 1986;68:765–769.
Katz M, Newman RB, Gill PJ . Assessment of uterine activity in ambulatory patients at high risk of preterm labor and delivery. Presented at the Annual Meeting of the Society of Perinatal Obstetricians, Las Vegas, Nevada, February 1985.
Iams JD . Atherosclerosis: a model for spontaneous preterm birth. Prenat Neonat Med 1998;3:138–140.
Iams JD, Newman RB, Thom EA, et al. for the National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Frequency of uterine contractions and the risk of spontaneous preterm delivery. N Engl J Med 2002;346:250–255.
Spong CY . No easy answers for predicting preterm labor (editorial). Obstet Gynecol 2002;100:219–220.
Lockwood CJ . Why do we do the things we do? Contemp Obstet Gynecol March 2002;11–15.
Commentary: Frequency of uterine contractions and risk of spontaneous preterm delivery. Am College Obstet Gynecol Clin Rev July/August 2002;5.
Aubry RH, Pennington JC . Identification and evaluation of high-risk pregnancy: the perinatal concept. Clin Obstet Gynecol 1973;16:3.
Nageotte MP, Dorchester W, Porto M, et al. Quantification of uterine activity preceding preterm, term, and post-term labor. Am J Obstet Gynecol 1988;158:1254–1259.
Dyson DC, Crites YM, Ray D, et al. Prevention of preterm birth in high-risk patients: the role of education and provider contact versus home uterine monitoring. Am J Obstet Gynecol 1991;164:756–762.
Mou SM, Sunderji SG, Gall S, et al. Multicentered randomized trial of home uterine activity monitoring for the detection of preterm labor. Am J Obstet Gynecol 1991;165:858–866.
Wapner RJ, Collin DM, Artal R, Librizzi RJ, Ross MG . A randomized multicentered trial assessing a HUAM device used in the absence of daily nursing contact. Am J Obstet Gynecol 1995;172:1026–1034.
US Preventive Services Task Force. Home uterine activity monitoring for preterm labor. JAMA 1993;270:369–370.
American College of Obstetricians and Gynecologists. Committee on Practice Bulletins. Assessment of risk factors for preterm birth. Washington, DC: ACOG; 2001. ACOG Practice Bulletin No. 31.
Iams JD, Johnson FF, O'Shaughnessy RW, et al. A prospective random trial of home uterine activity monitoring in pregnancies at increased risk of preterm labor. Part II. Am J Obstet Gynecol 1988;159:595–603.
The Collaborative Home Uterine Monitoring Study (CHUMS) Group. A multicenter randomized controlled trial of HUAM: active vs sham device. Am J Obstet Gynecol 1995;173:1120–1127.
Dyson DC, Danbe KH, Bamber JA, et al. Monitoring women at risk for preterm labor. N Engl J Med 1998;338:15–19.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Newman, R. Our Unrequited Love for Simple Explanation. J Perinatol 23, 504–506 (2003). https://doi.org/10.1038/sj.jp.7210958
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7210958