Hans van den Heuvel

8 INTRODUCTION Worldwide, the number of women at increased risk for complications in pregnancy continues to grow due to unhealthy lifestyle, obesity, advanced maternal age at conception and concurrent comorbidities. 1-3 High-risk pregnancy is defined as any pregnancy in which there is a factor—maternal or fetal— that potentially acts adversely to affect the outcome of pregnancy, for example preterm rupture of membranes (PROM), fetal growth restriction (FGR) and preeclampsia (PE). 4 International guidelines recommend increased monitoring and observation of maternal and fetal parameters, which essentially leads to hospital admittance. 5-7 Hospital admission during pregnancy is considered to be an event of significant impact, because of combined stressors of both pregnancy and hospitalization. 8 In previous quantitative studies on hospitalization during high risk pregnancy, women report lower self- esteem, greater anxiety and depression and less optimal family functioning. 9 Experienced fear, anxiety for the unknown and perceived immobility and inactivity are amongst stressors and emotions during hospitalization. 10-12 Besides conventional care during clinical admission, recent technological advances resulted in e-Health, defined as health services and information delivered or enhanced through the Internet and related technologies. Potential positive effects of the use of these forms of e-Health include increased patient engagement and satisfaction, better access to health care and the possibility to reduce clinic costs with equal or better health outcomes. 13 14 e-Health has already found its way in perinatal care and its implementation is likely to disperse globally in the next decade. 15 Telemonitoring of fetal heart rate combined with uterine contractions in complicated pregnancies is possible with help of a wireless portable cardiotocography (CTG) system combined with a blood pressure monitor. Measurements from home are saved in a personal profile using Bluetooth. Through a secured internet portal, data are integrated in the electronic patient record system making access possible for health care professionals. In recent years, several comparable systems for remote monitoring of maternal and fetal condition have been developed and found feasible with regards to usability, acceptability and clinical usefulness. 15 As an addition to prenatal care, telemonitoring can result in increased adherence to appointments, reduced clinic visits and enhanced patient engagement. 15 However, safety of use for perinatal outcomes of these digital telemonitoring platforms has not been studied extensively in high-risk pregnancy. As an essential component in the quality of health care, patients’ involvement in the development and implementation of e-Health strategies gives relevant information to improve the use in daily practice. 16 This study aimed to assess the experiences of pregnant women during clinical hospital admission and the novelty of telemonitoring during high risk pregnancy. USER EXPERIENCES OF HOME-BASED TELEMONITORING IN PREGNANCY 127