Hans van den Heuvel

trials have proved that home monitoring with home visits is feasible and safe regarding perinatal outcome. 21,22 These trials demonstrated satisfactory outcomes for both mother and child but also that daily visits are time consuming and therefore expensive. Again, telemonitoring may be an important solution as a replacement of hospital admission in this high risk pregnancy group. In women with fetal growth restriction, preeclampsia, preterm rupture of membranes and fetal anomalies, daily monitoring is required to assess fetal and maternal condition. Cardiotocography is needed for this assessment, next to blood pressure and urinary and blood analysis. The development and availability of a wireless, portable CTG system (Sense4Baby) has facilitated self-monitoring of fetal heart rate and uterine contractions. A considerable amount of time could be saved when the patient will take the measurements of CTG and blood pressure at home. These measurements are evaluated in the clinic by professionals on daily basis. This form of telemonitoring could therefore reduce costs and might offer an acceptable substitution to hospital admission from the patient’s point of view. However, up to now there are clinical trials evaluating safety, patient and professional satisfaction and cost-effectiveness of this novel strategy in high-risk pregnancy. Patients’ involvement in thedevelopment and implementationof e-Health strategiesprovides insights to improve the use in daily practice. In Chapter 8 , we describe the experiences of pregnant women during either hospital admission because of pregnancy complications, opposed to women who participated in a pilot with telemonitoring. Currently, a number of obstetrics units in the Netherlands offer home monitoring and telemonitoring to women with pregnancy complications. Chapter 9 is the report of a nationwide survey to all Dutch obstetric departments to determine the number of centres that provide home- and telemonitoring, and to identify the current practice of out-of-hospital care in high-risk pregnancy. In Chapter 10 , the protocol of the HOTEL trial is described: Ho spital care versus Tel emonitoring in high-risk pregnancy. This multicentre randomized controlled trial aims to compare telemonitoring at the patient’s home versus hospital admission with regard to perinatal outcome, patient satisfaction, preference of care and cost-effectiveness. The thesis is concluded by a general discussion of all results. The implications of the results will be discussed with additional considerations regarding the use of digital health in pregnancy and childbirth care. Lastly, discussed themes in this discussion are concluded with several recommendations for clinical practice and research in the years to come ( Chapter 11 ). CHAPTER 1 14