JMIR Publications

ABSTRACT

Background:

Daily monitoring of fetal and maternal condition in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home monitoring with home visits by professionals or telemonitoring with self-measurements, performed by pregnant women and uploaded for in-clinic assessment. In these alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to which extent these strategies are used, for which reasons, nor for which pregnancy complications. Answers to these questions are relevant for clinicians planning to use a telemonitoring strategy in prenatal care, as well as for researchers and health insurance companies in this field.

Objective:

to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by obstetric professionals) and telemonitoring (using devices and Internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring, in the Netherlands.

Methods:

An online survey was sent to all 73 obstetric departments of hospitals in the Netherlands to be answered by one representative per hospital, dedicated to pregnancy monitoring. Primary outcome was the provision of home- and/or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home- and telemonitoring, including (contra-)indications and (dis-)advantages for pregnant women and clinicians.

Results:

Response rate regarding the provision of home- or telemonitoring was 100%. In 2018, 28 out of 73 centers in the Netherlands (38%) offered either home monitoring, telemonitoring or both to pregnant women with complications. Home monitoring was offered in 19 centers (26% of all hospitals), and telemonitoring in 17 centers (23) and 8 centers offered both. Telemonitoring was first offered in 2009 and increased from 3 hospitals in 2014 (4%) to 17 in 2018 (23%). Responses from 57 surveys of 73 invited hospitals (response rate 78%) were analyzed. Of 17 centers using telemonitoring, 59% did not investigate perinatal outcomes, safety and patient satisfaction prior to implementation. Six other telemonitoring centers were participating in an (ongoing) multicenter randomized clinical trial comparing patient safety, satisfaction and costs of telemonitoring with standard hospital admission. Home- and telemonitoring is provided for a wide range of complications such as fetal growth restriction, preeclampsia or preterm rupture of membranes. Respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. Addressed barriers included lack of reimbursement possible technical issues.

Conclusions:

Home monitoring is provided in 26% and telemonitoring in 23% of hospitals in the Netherlands to women with complications of pregnancy. Altogether, 38% of hospitals offer home monitoring, telemonitoring or both as an alternative for hospital admission. Future research is warranted to assess safety and reimbursement issues before widespread implementation of this increasing practice.