Hans van den Heuvel

1 Moreover, a vast majority of women with hypertension in pregnancy reported they would like to be involved in the management of their condition. 18 Accurate measurement of blood pressure during pregnancy is essential to assist in decision making for both maternal and fetal/neonatal health. As vascular and hemodynamic changes occur in pregnancy, guidelines recommend that devices need to be validated before use in a pregnant population and specifically for pregnant women with pre-eclampsia. 19,20 In the developmental phase of our platform, we performed a validation study of two automated blood pressure monitors with Bluetooth for the connection with a smartphone application, which is described in Chapter 3 . The telemonitoring platform, consisting of a smartphone application and connected BP monitor, was subsequently tested in a group of low-risk pregnant women, without risk factors for hypertension. The objective was to assess participant compliance, efficacy of the automatic alert system and the usability and user satisfaction of the platform. The results of this feasibility study are outlined in Chapter 4 . In Chapter 5 we aim to assess the effects of our telemonitoring platform in women at high risk for hypertensive complications in pregnancy. This is the SAFE@HOME study. We compared a prospective cohort of pregnant women with telemonitoring and a predefined reduced antenatal visit schedule to a retrospective cohort of women managed with usual care, without self-monitoring of blood pressure. Outcomes of interest are healthcare consumption, user experiences and maternal and neonatal perinatal outcomes. In Chapter 6 we describe the economic evaluation of the results of the digital health study of Chapter 5. Furthermore, we assessed the experiences of the participants in the SAFE@HOME study with both surveys and interviews. This mixed-models study is presented in Chapter 7 . PART 2: TELEMONITORING OF PREGNANT WOMEN WITH COMPLICATIONS IN PREGNANCY The second part of the thesis focuses on pregnant womenwith complications requiring daily monitoring of vital parameters of both mother and fetus until delivery. In the Netherlands, obstetric departments started to provide domiciliary care or “home monitoring” to risk pregnancies requiring daily monitoring. from 1990 onwards. As an alternative to clinical admission, home monitoring involved hospital-employed midwives or nurses visiting pregnant women with complications at home, on a daily basis, to perform medical tests, including CTG, and discuss results with a supervising gynaecologist. Multiple randomised INTRODUCTION 13