Remote home cardiotocography: A systematic review and meta-analysis

Area of Science:

• Obstetrics and Gynecology
• Digital Health Technologies
• Fetal Monitoring

Background:

• Cardiotocography (CTG) is standard for assessing fetal health during pregnancy.
• Digital advancements allow for home-based CTG monitoring, expanding accessibility.
• Evidence on the effectiveness and practicality of home antenatal CTG is evolving.

Purpose of the Study:

• To systematically review and synthesize evidence on home antenatal CTG monitoring.
• To evaluate its effectiveness, feasibility, accuracy, and economic impact compared to conventional care.
• To identify gaps in current research for future high-quality studies.

Main Methods:

• Comprehensive literature search across major databases (MEDLINE, EMBASE, Cochrane, Web of Science, PubMed) up to June 2025.
• Inclusion of randomized controlled trials (RCTs) and observational studies on home antenatal CTG.
• Meta-analysis for RCTs (perinatal mortality, emergency C-section) and narrative synthesis for observational studies (feasibility, accuracy, cost).

Main Results:

• Home antenatal CTG monitoring was non-inferior to conventional care across maternal, perinatal, and healthcare usage outcomes.
• Feasibility and remote interpretation of home CTG were rated positively, despite occasional transmission issues.
• Patient and provider acceptability was high; implementation costs were offset by savings, though evidence quality was low.

Conclusions:

• Home antenatal CTG monitoring shows promise as a viable alternative to traditional care for fetal surveillance.
• Current evidence, primarily of low quality, supports its non-inferiority but necessitates further high-quality research.
• Standardized outcome assessment and detailed methodological reporting are crucial for definitive recommendations.