Hans van den Heuvel

RESULTS Current provision of home monitoring and telemonitoring in high-risk pregnancy In 2018, 73 hospitals in the Netherlands provided pregnancy and childbirth care. The principle question (Does your center currently offer home- or telemonitoring in pregnancy?) was answered by all 73 invitees, resulting in a response rate of 100%. In 2018, 19 out of 73 hospitals (26%) offered home monitoring with home visits by an obstetric professional (nurse or midwife) for high-risk pregnancy. A total of 17 of 73 hospitals offered telemonitoring in 2018 to high-risk pregnant women, which is equivalent to 23% nation-wide (Table 2). Eight centers reported they offered both home monitoring with home visits as well as telemonitoring to their patients. Table 2 The number of hospitals offering home monitoring and telemonitoring in risk pregnancy, in 2018, in relation to the number of births per hospital per year. Number births / hospital / year Number of hospitals Home monitoring, Telemonitoring n (% within same category) n (% within same category) 0-1000 15 0 1 (7%) 1001-2000 35 9 (26%) 8 (23%) 2001-3000 21 9 (43%) 6 (29%) 3000+ 2 1 (50%) 2 (100%) Total 73 19 (26%) 17 (23%) In obstetric departments with <1000 births/year, home monitoring and telemonitoring is limited to 0 and 1 center, respectively. As for different types of hospitals, eight of nine Dutch tertiary care hospitals with NICU facility currently work with either home- or telemonitoring (or both) in risk pregnancy management. Geographic distribution of hospitals with home monitoring (HM) and telemonitoring (TM) is displayed of all 12 provinces of the Netherlands in Figure 2. For the studied period of 1995-2018, the trend line in Figure 3 shows that home monitoring in pregnancy has been offered since the mid 1990s. Most of these centers kept offering daily home visits over a longer period of time, with a peak in 2015. After the introduction of pregnancy telemonitoring in 2009, the trend line of telemonitoring shows a steep increase in use from 2014 onwards: from 3 centers in 2014 (4% of hospitals in the Netherlands) to 17 centers in 2018 (23%). This increasing number is accompanied by a slight drop in home monitoring provision. CHAPTER 9 148