Hans van den Heuvel

ABSTRACT 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 For this nationwide cross-sectional study, 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 and possible technical issues. Conclusion 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. CHAPTER 9 144