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

Remote and home-based fetal heart rate monitoring may improve access, convenience, and continuity of care, but whether it provides perinatal safety and obstetric outcomes comparable to conventional in-person monitoring remains uncertain. Objective To evaluate whether remote fetal heart rate monitoring is associated with neonatal and obstetric outcomes comparable to conventional in-person fetal heart rate monitoring in randomized controlled trials. Study Design MEDLINE, 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 for additional eligible trials. Randomized controlled trials enrolling pregnant individuals undergoing antenatal surveillance or intrapartum monitoring were eligible if they compared remote or home-based fetal heart rate monitoring with conventional in-person monitoring and reported obstetric or perinatal outcomes. Results Eight randomized controlled trials enrolling 1,813 pregnancies were included. One trial was judged at low risk of bias, 3 had some concerns, and 4 were judged at high risk. Six trials (n=1,648) reported 5-minute Apgar scores <7; the pooled risk ratio was 1.01 (95% CI, 0.73–1.39; I²=0%; τ²=0.00), representing moderate-certainty evidence. Cesarean delivery was reported by all 8 trials (n=1,813); the pooled risk ratio was 1.09 (95% CI, 0.94–1.26; I²=0%), also representing moderate-certainty evidence. Prespecified subgroup analyses showed no evidence that effects differed by monitoring timing (antepartum vs intrapartum; Qb=1.26, P=.26) or publication era (≥2015 vs <2015; Qb=1.52, P=.22). Conclusions In randomized evidence, remote and home-based fetal heart rate monitoring was not associated with differences in 5-minute Apgar scores <7 or cesarean delivery compared with conventional in-person monitoring. Findings were consistent across monitoring settings and technology eras, although several trials had high risk of bias and neonatal outcomes beyond Apgar score were inconsistently reported. Adoption should therefore consider not only short-term perinatal safety but also access, patient satisfaction, hospital utilization, clinician workload, data reliability, cost, and infrastructure for timely clinical response.