Remote and home-based fetal heart rate monitoring for fetal surveillance compared with conventional in-person monitoring: a systematic review and meta-analysis of randomized controlled trials.

Abstract

ObjectiveTo evaluate whether remote fetal heart rate monitoring (FHRM) is associated with neonatal and obstetric outcomes comparable to conventional in-person fetal heart rate monitoring in randomized controlled trials.Data sourcesMEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database inception through November 25, 2025. Reference lists of relevant reviews and included studies were screened to identify additional eligible trials.Study eligibility criteriaRandomized controlled trials enrolling pregnant individuals undergoing antenatal surveillance or intrapartum monitoring were eligible. Studies comparing remote or home-based FHRM with conventional in-person monitoring were included if they reported obstetric or perinatal outcomes.ResultsEight randomized controlled trials enrolling 1,813 pregnancies were included. One trial was judged low risk of bias, three had some concerns, and four were judged high risk. Six trials (n=1,648) reported 5-minute Apgar scores below 7; the pooled risk ratio was 1.01 with a 95% CI of 0.73 to 1.39; I²=0% τ²=0.00, moderate-certainty evidence. Cesarean delivery was reported by all 8 trials (n=1,813); the pooled risk ratio was 1.09, with a 95% CI of 0.94 to 1.26; I²=0 percent; moderate-certainty evidence. Prespecified subgroup analyses by monitoring timing (antepartum versus intrapartum; Qᵇ=1.26, p=0.26) and publication era (≥2015 versus ConclusionsRemote and home-based FHRM was associated with 5-minute Apgar <7 and cesarean delivery rates comparable with conventional in-person monitoring in available randomized evidence. The negligible heterogeneity across older telemetry systems and contemporary digital platforms support consistency of these findings; however several trials had high risk of bias and neonatal outcomes beyond Apgar score were inconsistently reported. Adoption should therefore be guided not only by short-term perinatal safety, but also by access, patient satisfaction, hospital utilization, clinician workload, data reliability, cost, and timely response infrastructure.