Hans van den Heuvel

2 In a pilot with remote monitoring with transabdominal f-ECG after induction with dinoprostone pessaries (n=70), successful monitoring was obtained in 89%. 73 Three women were recalled to the hospital due to suspicious f-ECG, of which in two cases caesarean section was indicated. ‘Virtual Obstetric Care’ with normal visits combined with teleconferencing visitsforlow-riskpregnancyshowednoincreasedrisksinhealthoutcomesbesidesanincrease in preeclampsia diagnosis. 74 Another demonstration project describes a promising system of a wirelessly enabled maternal-fetal monitoring system “MiBebe”, used for the improvement of perinatal care in rural regions in Mexico. In the group of 153 high-risk pregnancies, the remote monitoring in 74 patients resulted in markedly increased adherence to antenatal visits with no adverse health outcomes compared to usual care. 75 One pilot describes an alternative prenatal care schedule, including an integrated technology platform (mobile app, wireless weight scale and BP cuff), leading to a 43% reduction in outpatient visits (8 vs 14 visits). 76 There was an increase in satisfaction, patient engagement and no change in perinatal outcome despite the decrease in face-to-face contact. 76 Remote monitoring and consultation can potentially reduce outpatient visits for antenatal consultation as well as hospitalization for certain clinical reasons. We see this inmanaging gestational diabetes with glucose monitoring but also in fetal monitoring for IUGR. 53,77 A model of cost-effectiveness analysis in a tertiary hospital (Ghent, Belgium) predicted a cost-reduction of 145,822 euro per year achieved by introducing home monitoring in high risk pregnancy. 78 Patient and caregiver experience Examiningpatients’ satisfactionwith e-health interventions, users describehigh convenience and acceptance resulting in more patient activation and education. Patients report less concerns, anxiety and are comfortable with fewer clinic visits. Satisfaction rates vary between 86-95% in e-mental health studies and 90% (46/51) in home-monitored induction patients, who were very glad to stay in their own, homely ambience as long as possible. 73,79 On the health care providers’ point of view, adaptation of obstetricians and midwives to e-health solutions has not been widely described. Only one qualitative study interviewed 12 health care providers in obstetric departments. Concerns were raised on implementation barriers and potential medico-legal risks but if addressed properly, implementation was considered feasible. Some clinicians admitted to have insufficient familiarity and skill with e-health limiting their engagement and comprehension of the possibilities that e-health technologies can confer to perinatal care. Overall these clinicians regarded telemedicine as an additional parallel service rather than integrated into the antenatal care model. 27 LITERATURE OVERVIEW OF E-HEALTH IN PERINATAL CARE 27