Hans van den Heuvel

9 Table 4. Indications for home monitoring (n = 19 hospitals) and telemonitoring (n= 17 hospitals) Indications Home monitoring centers n (%) Telemonitoring centers n (%) Fetal growth restriction 19 (100%) 17 (100%) Preterm premature rupture of membranes 19 (100%) 17 (100%) Prolonged prelabor rupture of membranes at term 5 (26%) 2 (12%) Isolated oligohydramnios 10 (53%) 4 (24%) Reduced fetal movements 15 (79%) 15 (88%) Fetal anomalies requiring fetal monitoring 9 (47%) 3 (18%) (Adverse) Obstetric patient history^ 16 (84%) 15 (88%) Hypertensive disorders of pregnancy 15 (79%) 10 (59%) Cholestasis of pregnancy 14 (74%) 5 (29%) Other maternal co-morbidity* 11 (58%) 4 (24%) Social or psychological distress 11 (58%) 5 (29%) ^ e.g. intrauterine fetal death in a previous pregnancy * e.g. (gestational) diabetes mellitus, kidney disease, cardiac disease requiring maternal monitoring All 18 homemonitoring centers reported that at home, midwives or nursesmeasure patients’ blood pressure and perform a CTG during their visits. In 15/18 centers (83%), it is possible to monitor fetal condition of both singleton and twin pregnancies using CTG. Additionally, urine analysis (72%), venous blood sampling (67%) and medication administration (22%) can be performed by the professional at home. This is in contrast to telemonitoring centers where no other tests besides blood pressure and CTG are performed by patients themselves, at home. Hospitals with either home- or telemonitoring also reported on patient-specific contra- indications for monitoring from home. These contra-indications were: impossibility to keep to agreements or difficulty to understand the system (94%), long home-to-hospital distance (89%), present antepartum hemorrhage (72%) and vulnerable home situation or social issues of the patient (50%). Other mentioned general contra-indications were: gestational age < 25 weeks, and PPROM without engaged fetal head or breech. To ensure the safety of the patients to minimize the travel time if complications occur, respondents made clear that patients must reside within 30 to 35 km away from their hospital. Reported (dis)advantages of home – and telemonitoring The most frequently addressed advantages of home-and telemonitoring for the patients, as perceived by the respondents, include more patient-comfort and less emotional burden of hospitalization for the patient, as they continue with daily (family) life and activities as much as possible. Other frequently mentioned advantages are summarized in Textbox 1. CURRENT PRACTICE OF HOME-BASED TELEMONITORING IN THE NETHERLANDS 151